Private KYC Reg Form

Private Limited Liability Company
Registration Form
Instructions:
Version 1.1
Complete every part of this form in BLOCK letters
Attach Photocopies of relevant documents
REGISTRATION REQUIREMENTS
1. Certificate of Incorporation;
2. Memorandum and Articles of Association [certified as true copy by the Registrar of Companies]
3. Form CAC 7 (formerly CO7 - Particulars of Directors) certified as a true copy by the Registrar of Companies;
4. Form CAC 2 (formerly CO2-statement of return on allotment of shares) certified as a true copy by the Registrar of Companies; or Form CAC 1.1 (Application for Registration of Company) for
entities incorporated post the executive order for Ease of Doing Business approved in 2017 (replaces Form CAC 2 and CAC 7);
5. Proof of business operating address for the company.
6. Primary Identification Documents of all Shareholders with 5% ownership and above;
7. Operating license (where applicable) for company operating in Nigeria and regulated by the CBN (e.g. Bureau De Change, Payment Solution Service Providers (PSSPs), Mobile Money Operators
(MMO), International Money Transfer Operators (IMTOs) etc.).
Any other document or licenses required for your specific business (e.g. SCUML, betting license etc.)
PRODUCT/ SERVICE CATEGORIES (Please tick ( ) as appropriate
AutoPay Quickteller PayDirect WebPay PAYPhone VTUCare
SmartCard Android POS PayCode Interswitch Digital Product RetailPAY
Customize POS Solution Interswitch Integrated Payment Platform
Interswitch Payment Gateway Others* (please specify)
COMPANY DETAILS (Please complete in BLOCK LETTERS and Tick where necessary)
Company/Business Name:
Registration Number:
Nature of Business:
Sector/Industry:
Operating Business/Office Address:
Registered Business Address:
Office Email Address: Office Phone Number :
Date of Registration : Tax Identification Number (TIN) :
Email Address: Website URL:
Doing Business As: Country Of Registration:
Description of Products/Services:
CONTACT INFORMATION
This section gathers information about the contact person in your organization. All correspondences between Interswitch and your organization will be addressed to the persons specified below
Primary Contact Person: Secondary Contact Person:
Designation: Designation:
Office Phone Number/Extension: Office Phone Number/Extension:
Mobile Phone Number: Mobile Phone Number:

BANK DETAILS
Account Name:
Account Number: Account Type: Bank:
OTHER INFORMATION
BOARD RESOLUTION
At the meeting of the Board of Directors of… ……………………………....................…………………………………………………………………....................………………………… ……………………………………………....................…………………………………(“the Company”)

held on the ___ day of _______________ 20___ at the Company’s Head Office, the following resolutions were proposed and duly passed:
That the Company is authorised to establish a business relationship with Interswitch Limited and acquire the above listed products and services from Interswitch Limited.
That the following persons should be recognised as the Company’s Representatives:
Primary Contact: [Name] ……………………………....................…………………………………………………………………....................………………………… ……………………………………………....................…………………………………..................................................................................................................
Secondary Contact:…[Name] ……………………………....................…………………………………………………………………....................………………………… ……………………………………………....................…………………………………..........................................................................................................

That any of the Company’s Representatives may request for a modification of the products/services and may request for new products/services from Interswitch Limited
from time to time.
Dated this ………. Day of ……………... 20…........
DirectorD irector/Secretary [Company Seal]:
Name: ………………………………...................... ....................................................................... . Name: …………………………….…………………………….........................................................................
Signature: …………………………............................................................................................. Signature…………………………...................................................................................................
DIRECTOR DIRECTOR /COMPANY SECRETARY
Shareholders Information
Serial Number Full Name %Ownership
ACQUIRING BANK DETAILS
Account Name:
Account Number: Account Type: Bank:
CERTIFICATIONS
I/We hereby certify that all information and documents submitted to Interswitch Limited are true, accurate and genuine. I/We shall indemnify Interswitch Limited against any loss,
expenses or damages it may sustain through our failure to notify Interswitch Limited of any alteration, amendment or addition to the information and documents submitted to
Interswitch Limited.
I/We understand that the information provided in this form may be shared between the Interswitch Group entities provided that the information shall be kept confidential and be utilised
only for the purpose of improving Interswitch’s product and service offerings to us.
Authorised Signatory: ……………………………....................…………………………………………………………………....................……………………………………………………………………………………………………………....................…………………………………………………………………....................………………………………….
Signature: ………………………………………………………………………...…………………………....................………………………………………………………………….............……………………………………………………....................…………………………………………………………………....................…………………………………………………...
Name: ……………………………………………………………………………………....................…………………………………………………………………...............……………………………………………………....................…………………………………………………………………....................…………………………………………………………………………..
Date: …………………………………....................…………………………………………………………………....................……………………………………………………………………………………………………………………....................…………………………………………………………………....................……………………………………………………………

Private KYC Reg Form

Uploaded by

Copyright:

Available Formats

Private KYC Reg Form

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Private KYC Reg Form

Uploaded by

Copyright:

Available Formats

Private Limited Liability Company

PRODUCT/ SERVICE CATEGORIES (Please tick ( ) as appropriate

AutoPay Quickteller PayDirect WebPay PAYPhone VTUCare

SmartCard Android POS PayCode Interswitch Digital Product RetailPAY

Customize POS Solution Interswitch Integrated Payment Platform

Interswitch Payment Gateway Others* (please specify)

Operating Business/Office Address:

Registered Business Address:

Office Email Address: Office Phone Number :

Date of Registration : Tax Identification Number (TIN) :

Email Address: Website URL:

Doing Business As: Country Of Registration:

Primary Contact Person: Secondary Contact Person:

Office Phone Number/Extension: Office Phone Number/Extension:

Mobile Phone Number: Mobile Phone Number:

Account Number: Account Type: Bank:

Director​​​​​​D irector/Secretary [Company Seal]:

Name: ………………………………...................... ....................................................................... . Name: …………………………….…………………………….........................................................................

Signature: …………………………............................................................................................. Signature…………………………...................................................................................................

DIRECTOR DIRECTOR /COMPANY SECRETARY

Serial Number Full Name %Ownership

ACQUIRING BANK DETAILS

Account Number: Account Type: Bank:

You might also like

DirectorD irector/Secretary [Company Seal]: