PayDollar Australia Payment Service Application Form Section A - Company Information Merchant Registered Name Registered Business Address (including State, Suburb & Postcode) Mailing Address Australian Company Number (ACN) Australian Business Number (ABN) Is the business registered for GST? Yes Non-profit Org. Yes No Ownership Type Sole Proprietor No Paid Up Capital (AUD) Country of Incorporation Partnership Australia No. of Employees Others: Limited Company Mobile No. Project Contact Position Office No. Fax Email Surname Given Name(s) Office Bearer (1) Office Bearer (2) (optional) Director Full Name Director Identity Card No. Nationality Director Passport No. Date of Birth Capacity Full Name Surname Given Name(s) Identity Card No. Date of Birth Passport No. Nationality Section B - Contact Information Website URL Target Launch Date (dd / mm / yyyy) Contact Email Tel. No. Operations (1) Operations (2) Technical (1) Technical (2) Financial Section C - Business Information Business Nature Target Customer Products and Services Online Payment Provider / Bank Current Annual Sales Volume for Past 2 Years Past Last Year Year Before Last Year AUD Section D - Online Business Courier / Delivery Provider Any Returns and Refunds Policy? Yes No Fulfillment Cycle Time Average Days between Payment and Delivery of Goods Receipt? Yes No Customer Service Hotline Average Transaction Amount Minimum Transaction Amount Maximum Transaction Amount After 3 Months After 6 Months After 1 Year AUD USD Forecast Monthly Sales Form ID: AU-SALE-M002 Page 1 Last Updated: April 28, 2022 - No. of Transaction - Sale Volume (AUD) Section E - PayDollar Service Plans and Solutions PayDollar eCommerce Service Plans (Premier Plan) Payment Choice Visa and Mastercard PayID Humm Alipay American Express POLi Zip WeChat Pay JCB Card Apple Pay Discover and Diners International Google Pay China UnionPay Samsung Pay PayPal (Please specify: Account Email: Currency: Currency AUD Contract Term 12 Months USD GBP NZD ) EUR 6 Months Value Added Payment Solution Direct Payment Link Service Multi-currency Processing Service Secure Batch Processing Customized Payment Page Member Payment / Tokenization Service Reference Payment Recurring (Schedule) Payment Online Card Promotion Service Mail / Phone Order Service Type of Shopping Cart Checkfront Drupal Magento OpenCart WooCommerce Application is subject to the approval by the banks and AsiaPay Australia Pty. Ltd (“AsiaPay”). Please return us the application form with the following documents by email at sales@asiapay.com.au 1. Copy of the ABN 2. Copy of the Certificate of Incorporation 3. Copy of the corporate account bank statement (recent 1 month) 4. Copy of Director’s ID or Passport Checklist for proceeding application 1. Accessible Webpage URL and Shopping Cart 2. Business name and Australian Business Number 3. Company information, Product / Service Description with transaction currency 4. Terms & Conditions, Refund Policy, Delivery Policy 5. Contact Information (e.g. Company address, service hotline, email) 6. Data Privacy Policy (e.g. Cookies) 7. Security Capabilities (e.g. SSL Certificate) 8. Payment Options and PayDollar Logos 9. Details of any Australian export restrictions (if applicable) Form ID: AU-SALE-M002 Page 2 Last Updated: April 28, 2022 10. Disclosure of surcharge on the website (if applicable) Form ID: AU-SALE-M002 Page 3 Last Updated: April 28, 2022 Merchant Online Business Declaration Part I: Merchant Business Nature Agree Disagree Agree Disagree a) Whenever there is any change in the business nature or goods and services sold, which is different from the information as stated on this PayDollar Payment Service Application Form, I will notify AsiaPay of the change at the earliest b) Do not participate in any of the restricted services i.e. products or services that constitute, relate to or are ancillary to, in whole or in part of: i. Pornographic or illicit material or activities of any type ii. Escort services iii. Gambling operations, including “virtual casinos” iv. Engaging in “receipt of payment in advance” operation module (e.g. pre-paid vouchers; beauty coupons; ticketing) – *Subject to bank’s approval* v. Pyramid selling or multi-levels commission earning structure vi. Goods, products, services or distributions prohibited by any applicable law or under the rules, regulatio