Merchant Application Form

Merchant Application Form

*Please take note that in order to qualify to become a BookCoins merchant, you will need to first buy silver bullion with the minimum amount of 50,000 grams. CORPORATION DETAILS Company Details Company Registration Number: Legal name of company: Registered address: Post code and city: Country: Primary Contact person- Name, phone number, fax and email: BANK ACCOUNT INFORMATION Settlement Bank Account Settlements to be made in the following bank account: Owner of account: Bank name: Bank contact person: Bank address: Bank tel/fax: SWIFT code: Account number: Account currency: IBAN: Page 1

WEBSITE DETAILS Applicant website/s: Login Details: User ID: Password: Type of Business: Descriptor: (merchant name to appear on credit card statement) IP Address: City Filed: (customer service phone number) Customer Support e-mail: Chargeback notification email: How long have you been in business: Previous/ current name of processor and/or acquirer: Current monthly sales volume: Current number of monthly transactions: Desired processing currencies: USD RMB Desired settlement currencies: USD RMB GBP GBP Other:... Other:... Do you use payment methods other than credit cards? Please specify: Other:... Do you preauthorize card transactions: Page 2

PROCESSING DETAILS Reason for applying for this merchant account: MOTO (Mail Order, Telephone Order) account needed: Projected monthly processing volume: Projected monthly number of transactions: Purchase details Payment Mode BookCoins Silver Amount (gram) Discount Rebate % 50,000 Cash Cheque 100,000-500,000 500,000 and above How do you receive your customer`s orders: Internet/ SSL Order (%): Telephone Order (%): Volume divided between cardholders: Domestic (%): US (%): Other (%): Volume divided between card types: Consumer Cards (%): Commercial Cards (%): Server to server integration requested (it is permitted solely at discretion of the processor): Name of Gateway: Use of fraud prevention techniques: Specify: If you block any countries for transactions, please specify: Specify: Page 3

BENEFICIAL OWNERS Please start with the largest shareholder Beneficial Owner # 1 Beneficial Owner # 2 Beneficial Owner # 3 First Name: Last Name: E-mail Address: Phone Number: Current home address: City and ZIP: Country: Passport Number: % Ownership: DIRECTOR(S) Director # 1 Director # 2 Director # 3 First Name: Last Name: E-mail Address: Phone Number: Current home address: City and ZIP: Country: Passport Number: Page 4

MERCHANT TECHNICAL CONTACT Name: Phone number & fax: E-mail address: INTEGRATOR TECHNICAL CONTACT Name: Phone number & fax: E-mail address: FINANCIAL CONTACT (ACCOUNT/ BILLING) Name: Phone number & fax: E-mail address: Page 5

WEBSITE CONTENT What is/ are the product/s or services sold on your website? Please specify the payment model (recurring, one-time payment, pay-per-minute, etc): What the cardholder will be paying for through your website: When is the customer charged for purchase (upon placing an order, when the order is shipped, upon receipt): Please specify the major countries your customers are from: Do you send an email receipt to the cardholder when the product has been fulfilled? If yes, please email us sample/s. Do you distribute any materials and/ or agreements to customers; related to the services offered? If yes, please email us sample/s. Do you have an appropriate business license for your business (ex. Pharmaceutical license for your company or your supplier`s license; gaming license)? If yes, please provide us with a copy. Does your company fulfil orders directly? If no, please provide fulfilment company information details: Specify: Do you operate any affiliate programmes? Are they involved in the processing on your website: Specify: Page 6

REQUIRED DOCUMENTS Incorporation documents: 1. Certificate of Incorporation for the Applying Company issued by the Company Registrar. * 2. Memorandum and Articles of Association for the Applying Company issued by the Company Registrar. * 3. Certificates listing the current directors, current shareholders and registered address of the Applying Company issued by the Company Registrar. * Personal information: 1. Passport Copies for the directors and beneficial owners and authorized signatories signing documents on behalf of the Applying Company. * 2. Original utility bill, personal bank statement or credit card statement (less than three months old), for address verification for each of the directors, beneficial owners and authorized signatories signing documents on behalf of the Applying Company.* In case of an Overlying Company(s) stated in the above mentioned corporate documents, please provide all documents listed in points 1 and 2 for it (them). * Processing statements or screenshots of current processing history showing the Applying Company s last 6 months monthly sales, chargebacks and refunds with volumes and counts included. ** 1. If there are any indications of elevated chargeback ratios, please provide an explanation as well as a chargeback reduction plan.* 2. If the applying business is a start-up and processing history is not available, please provide a detailed business plan including projected 000volumes, target markets and marketing strategies. * Most recent company bank statement or audited financial statements accompanied by a void check/bank letter validating the financial stability and confirming full settlement bank account details of the Applying/Overlying Company. * Declaration Letter signed by the beneficial owner of the Applying Company. * Copy of an operating license (if applicable - e.g. pharmaceutical license, gaming license, etc.) of the Applying Company. * * Original required upon approval. If original not available, certified copy of the original document authenticated by a tary Public, Attorney, Public Accountant or Consular Official to be a true copy of the original document is required. ** Digital Scan copy or print screens are sufficient. PLEASE NOTE THAT ADDITIONAL DOCUMENTS MAY BE REQUIRED THROUGHOUT THE APPLICATION PROCESS DEPENDING ON THE PARTICULAR SOLUTION. TRANSLATION OF DOCUMENTS MAY BE REQUIRED IF LANGUAGE IS DIFFERENT FROM ENGLISH. DISCLAIMER: Please note that completion of this form will not bind either BookCoins Limited or any of our acquirers to any particular course of action and submitting of the information requested in this form shall explicitly not create contractual relations between parties. Page 7

ACKNOWLEDGEMENT 1. I / We confirm that the information given herein by me is true and correct. I understand & must provide written notice to BookCoins on any change of information as bound by this application. I / We further agree that BookCoins reserves its rights not to accept this change without providing any reason and may lead to termination of the Merchant Agreements. 2. I / We understand that BookCoins may decline this application without giving any reason whatsoever. 3. I / We have read, understand & be bound to all clauses stated in the Merchant Agreement as spelled out and published at http://bookcoins.com/become-our-merchant/ and acknowledge that these clauses may be modified by BookCoins from time to time. I shall always keep myself updated on any modified clauses by visiting the above URL. 4. I/We am/are aware in order to qualify as a BookCoins merchant, I/We will need to first buy silver bullion in bulks with the minimum amount of 50,000 grams of BookCoins Silver. 5. I / We agree to accept the Fee, Rate & Service Charge that have been offered by BookCoins as per Annexure(s) attached and BookCoins reserves its rights to change the said Fee, Rate & Service Charge by giving one 30 days written notice. 6. I / We agree certain transaction amount shall be kept by BookCoins (collectively "Security Deposit(Holdback)"). This amount will be used to refund the credit card member if the card member disputed the transaction successfully. 7. I / We agree to responsible fully for any disputed amount received. 8. I / We confirm & agree not to make any change and/or new add in of Product(s) sold / Services(s) offered online on my / our website and/or URL/Domain that is different from this application. In the event of change and/or new add in of Product(s) Sold / Services (s) Offered online and/or URL/Domain, I / We must give thirty (30) days prior written notice to BookCoins and understand this request shall be deemed as a new application. BookCoins shall at its sole discretion to reject or accept this new application by revising the Fees, Rates, Service Charges, Terms and Conditions offered herein. 9. I / We further undertake that I / We shall not: (i) Upload the high risk product(s) such as handphones, laptops, computer accessories, cameras, IT gadgets, jewelries, electronics, telecommunication equipments, etc. and/or instant delivery product(s) and/or service(s) likes prepaid values, games points, software, downloadings, hostings, subscriptions, telemarketings, auctions, travels, etc. at my/our website; and/or (ii) Involve in any business activity related to Penny Auction / bidding, wholesale and/or online shopping mall. Unless prior written approval has been granted by BookCoins with additional Fees, Rates, Service Charges, Terms & Conditions, whichever is applicable. 10. I / We agree to accept all Terms and Conditions that accompany the usage of BookCoins Service(s). These Terms and Conditions are subjected to be revised by BookCoins and I will be notified in a manner as BookCoins deems appropriate. 11. I/We agree the paid setup cost is not refundable once this application is accepted and approved by BookCoins. Page 8

FOR OFFICE USE ONLY Application Status: Application approved Application rejected Further information required Reason / Comments: Date: Written by: Signature: Page 9