©2014 Vogue Web Solution

MERCHANT BUSINESS VERIFICATION FORM

Please complete this form and provide documentary evidence as appropriate. Falsification, misrepresentation of information and submission of fraudulent documentation may lead to refusal of this application and denial of service.

INSTRUCTIONS

1) All fields marked * (asterisk) are COMPULSORY 2) All Sections should be completed in BLOCK letters/CAPITALS 3) Attach copies of relevant documents including Certificate of Company’s registration or Government Issued Identification Cards as may apply

CONTACT INFORMATION 1

This section gathers information about the contact persons for your organization. VoguePay will

contact you through the information provided here.

Name of Principal Contact

Name of Secondary Contact

Position Position

Office Telephone & Extension Office Telephone & Extension

Mobile Phone Mobile Phone

email Address email Address

BUSINESS INFORMATION 2

Please complete this section with information about your organization.

Office Address

Registration Certificate No

Principal Officer’s ID No

Date Issued

Account Username (on VoguePay) Account email Address

Business Type (please tick)

Sole Proprietorship

Partnership/Joint Venture

Limited Liability Company (LLC)

Public Liability Company (PLC)

Non-Profit Organisation (NGO)

Religious Organisation

Government

Other (Please Specify)

This is a three (3) page document ©

2014 Vogue Web Solution

WEBSITE INFORMATION 3

This section collects information about the products/services you intend to render on the site

Website Name

Website URL

Description of Services/Goods to be sold on site

BANK INFORMATION 4

Please provide details of the business’ primary bank account. Bank Name

Bank Branch

Bank Address

Account Name

Account Number Country where Bank is domiciled

OTHER INFORMATION 5

Account Type (please tick)

Current Account

Savings Account

Other (Please Specify)

Please provide any other relevant information here

This is a three (3) page document ©

2014 Vogue Web Solution

ATTESTATION 6

I ________________________ on behalf of ________________________ confirm that the information provided herein are accurate and true. I also confirm that I am authorized to make this attestation. I agree that VoguePay reserves the right to take appropriate measures including legal actions if the information here is discovered to be false. I agree that I will provide VoguePay with details about any transaction performed on the site upon demand. Authorized Signature & Date __________________________ Position ________________________