FASS PAYMENT SOLUTIONS SDN. BHD. Registration No.

: 201201032773 (1017261-P)
FASSPAY MERCHANT APPLICATION FORM
The Merchant Acquiring Services Agreement (together with this Fasspay Merchant Application Form, Letter of Offer and all the Schedules including
its Appendices) (“Agreement”), is entered into by and between Fass Payment Solutions Sdn. Bhd. (“Fasspay”) with its principal place of business at
Unit 15-15, Level 15 Q Sentral, 2A, Jalan Stesen Sentral 2, Kuala Lumpur Sentral, 50470 Kuala Lumpur, Malaysia and the entity identified below
(“Merchant”).

SUBSCRIPTION DETAIL Form ID

Service requested: ☑ MyDebit; ☐ VISA / MasterCard (coming soon); ☐ Superks loyalty platform; ☑ e-Wallet / QR
Acceptance point type: ☐ Android NFC phone; ☐ K9 terminal; ☐ F30 terminal; ☐ mPOS terminal No. requested:
PIC INFORMATION
Name: Name:
Role: Owner/Shareholder, Director, etc PIC 2 Role: Owner/Shareholder, Director, etc
PIC 1
E-mail: (if any) E-mail:
Contact: Contact:
BUSINESS INFORMATION
Business name:
Business type: ☐ Not registered; ☐ Sole prop; ☐ Partnership; ☐ Sdn Bhd; ☐ Bhd Reg. no:
Has business license? ☐ Yes; ☐ No Type (if yes): License no:

Business address: number, street, city (1) Post code:

number, street, city (2) State:

Web/Soc. media URL: Phone:
Fax:

BUSINESS PROFILE
Business industry: (e.g. F&B, Retail, Entertainment, Travel, etc)
Details of business: (i.e. details of goods and services sold)

Business Operation: (e.g. Mon-Fri, 3pm-9pm)

Years in business:
BUSINESS OUTLET INFORMATION
DBA / Trading name:
Outlet address: (write "As Above" if same as business address) Post code:
State:
TRANSACTION PROFILE SALES PROFILE (%)
Average transaction size (RM): Cash (in-store):
Note: If your business
Max. daily sales (RM): Non-cash (in-store):
is still new or less than
Total annual sales (RM):
1 year, please write
Do you offer prepayment? ☐ Yes; ☐ No e-Commerce:
the expected amount.
If yes, what is (%) of sales? TOTAL 100

Currently accept Visa/MasterCard/MyDebit? ☐ Yes; ☐ No Name of acquiring bank:

MDR (%), debit: Average transaction size (RM):
MDR (%), credit: Monthly card sales (RM):
BANK ACCOUNT DETAILS (FOR BILLING & SETTLEMENT)
Bank name:
Account number:
Beneficiary name:
Branch:
Finance contact: name, contact number, email

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FASS PAYMENT SOLUTIONS SDN. BHD. Registration No.: 201201032773 (1017261-P)
FASSPAY MERCHANT APPLICATION FORM
DOCUMENT SUBMISSION CHECKLIST
1. ☐ Photocopy ID of AuthorisedPerson or Director/Owner/Shareholder
A. Compulsory for all applications
2. ☐ Copy of latest bank statement
B. If requested 3. Photographs of ☐ Business Outlet and ☐ Goods and/or ☐ Services sold
C.i If requested - Sole Prop./P'tnership 4. ☐ Form D / SSM Cert
5.a: After Companies Act 2016 - ☐ Section 14, ☐ 15, ☐ 17, ☐ 58 & 236(2)
C.ii If requested - Sdn. Bhd. / Bhd.
5.b: Before Companies Act 2016 - ☐ M&A, ☐ Form 9, ☐ 24, ☐ 49
6. ☐ Board Resolution/ ☐ Letter of Authorization (if sign not director) [click for template]
7. ☐ Business License (e.g. Local Authority License, Travel License, Direct Selling License, etc)
D. If requested - Others
8. ☐ Audited Financial Report
9. ☐ Copy of PCI DSS Certificate
CUSTOMER SERVICE

All questions regarding Payment Services should be referred to Fass Payment Solutions Sdn. Bhd. at the address set forth below or
WhatsApp us at the number +6 010 200 1123

Fass Payment Solutions Sdn. Bhd.

Unit 15-15, Level 15 Q Sentral, Leve 2A, Jalan Stesen Sentral 2,
Kuala Lumpur Sentral, 50470 Kuala Lumpur, Malaysia.

For general support: [email protected]

DECLARATION & SUBMISSION

Fasspay Merchant Services Application T&C
I/We confirm and certify that all information contained in this Fasspay Merchant Services Application Form and other
documentation, submitted in support of this application are complete, true and correct.

I/We hereby authorize and expressly consent to Fass Payment Solutions Sdn. Bhd. (“Fasspay”) to use, collect, record, store, share
and process my/our personal information, including, without limitation, my/our contact details, background information, financial
data and other information relevant to my/our application. I/We hereby further authorize Fasspay to verify the information from
any source and by whatever means Fasspay considers appropriate and I/We shall be bound by the terms and conditions of the
Merchant Acquiring Services Agreement entered between Fasspay and I/us.

I/We hereby expressly consent for Fasspay to disclose my/our personal data (as defined under the Personal Data Protection Act
2010) to any credit reporting agency in Malaysia to conduct credit checks and I/We hereby consent to the credit reporting agency to
disclose the my/our credit report (as defined under the Credit Reporting Agencies Act 2010) to Fasspay. I/We authorize Fasspay to
seek the disclosure of my/our credit reports, from time to time in connection with the application, distribution and provision of
products and services, even if the relationship between Fasspay and I/us may have been terminated and/or an event of default has
occurred. I/We hereby agree that all information obtained by Fasspay pursuant to this application may be disclosed by Fasspay to
any person and for any purpose as Fasspay may deem fit or proper at any time and from time to time at its sole and absolute
discretion.

I/We understand that I/We have two options to accept Debit Cards: MyDebit Routing and International Debit (Scheme) Routing.
Either routing option will allow me/us to accept all Debit & Credit Cards. In the event that I/We do not exercise out right in priority
routing, I/We understand that Fasspay will route the transaction to the most cost-effective debit card network.

By signing this Agreement or, in the event an electronic version of this Agreement is used, by clicking the button “I Confirm” or
similar button, registering, accessing or using the Merchant Services, I/we enter into a legally binding agreement with Fasspay which
will take effect on the date signing this Agreement by me/us (“Effective Date”). I/we agree to accept the terms and conditions set
out in this Agreement and as stated in the Fasspay Merchant Terms of Service available at https://fasspay.com/support/terms-
service, and I/We understand that Fasspay has the right to reject my/our application and is not obliged to provide any reason for
such rejection or to respond any request for information.

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FASS PAYMENT SOLUTIONS SDN. BHD. Registration No.: 201201032773 (1017261-P)
FASSPAY MERCHANT APPLICATION FORM
Fasspay e-Wallet Merchant Services Application T&C
Fass Payment Solutions Sdn Bhd (“Fasspay”) is an approved issuer by Bank Negara Malaysia to issue electronic money (e-money) via its
mobile application, pursuant to Section 11 of the Financial Services Act 2013.

I/We hereby declare that (a)I/we authorized to execute this Merchant Application Form; (b) all information provided herein is true and
correct; (c) all original documents provided to Fasspay are genuine and updated; and (d) all photocopies provided to Fasspay are true
copies of the original documents. I/We undertake to notify Fasspay in writing if there is/are any change(s) on the information provided to
Fasspay earlier.

I/We further authorize Fasspay to verify the information/documents given by me/us from any source (including third parties and
regulatory bodies) and in such manner as Fasspay shall deem fit.

Fasspay shall have the right to request for further information to verify the user account details or merchant account, and has the right to
access account information at any time but shall not use the information for any purposes except where legally required to do, or to verify
your identity in the event of suspicious activity or suspected fraudulent behavior.

I/We agree to be bound by the Fasspay Merchant Terms of Service available at https://fasspay.com/support/terms-service at the date of
this Application Form. Fasspay reserves the right to approve or reject my/our application for any reason.

I/We have understood all requirements indicated by Fasspay and will ensure that total compliance is met at all times. Any penalty imposed
due to non-compliance will be fully borne by me/us.

Refund / Void: Merchant needs to notify in writing to [email protected]. Void can only be performed on the same day as the
transaction.

Termination / Discontinuation: Merchant needs to notify in writing to [email protected]. Termination will be carried out 1 week
after receipt of written notice.
SUBMISSION Completed application with the necessary documents may be sent electronically to [email protected]

Name:
NRIC / Passport no:
Role and designation:
Date: Authorised Signature 1

Name:
NRIC / Passport no:
Role and designation: Authorised Signature 2
Date: (if any and required)

FOR OFFICE USE ONLY

Ref. partner name: Ref. ID:
MDR:
% MyDebit
% Visa/Mastercard
Official Company Stamp
Recommendation ☐ Approved; ☐ Not Approved
Remarks

Signature
Name
Designation
Date

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