INTERNET BANKING DOKU

LEMBAR PERSETUJUAN LAYANAN PEMBAYARAN INTERNET BANKING DOKU

A. DATA BISNIS MERCHANT
Nama Perusahaan Alamat Perusahaan Nomor Telephone Jenis Usaha Penerbangan Tour / Travel Elektronik Retail Donasi MLM Lain-lain : ____________________ Nomor Fax Website

B. DATA LAYANAN
No PKS DOKU : INTERNET BANKING KlikBCA MANDIRI BIAYA Transaksi DOKU : Rp. BANKs Others : Jangka Waktu :

Tanggal Perjanjian :

Jangka Waktu :

C. PELAKSANAAN BISNIS
Aplikasi ini menjadi satu kesatuan yang tidak terpisahkan dari syarat dan kondisi yang tercantum pada perjanjian kerjasama (PKS). Merchant menyetujui keterikatan kondisi yang berlaku dalam aplikasi serta lampiran didalamnya.Aplikasi ini hanya dapat direvisi atau dirubah oleh wakil yang ditunjuk secara tertulis dari kedua belah pihak . Aplikasi dan lampiran ini merupakan persetujuan akhir menggantikan penawaran yang ada sebelumnya meliputi pesanan pembelian maupun tagihan terkait. Nama Perwakilan Jabatan Alamat Email Nomor Telephone : : : :

merchant logo

Merchant Authorized Signatory

DOKU Authorized Signatory

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MERCHANT DOCUMENT

LEGAL DOCUMENTS
DOCUMENTS
KTP / KITAS / Passport SIUP / Certicate of Residence Tax Identication Number (NPWP) Deed of Establishment & the Changes Lembar Pengesahan Men-Kehakiman Rental or Lease Agreement / Contract / Ownership Merchant Request Form Sites Photo (front view, store signage, o ce view) Payment Account (Bank, Branch, Account No.) Form SP Debet (attached) E-Commerce Website Statement for EDU* availability E-Commerce Standard Operation Procedures (SOP) Additional Document : IATA / ASITA for Tour & Travels Merchants SP Debet for merchant HP, Jewellery, Computers

INDIVIDUAL,PD,UD

PT, CV, FIRMA,YAYASAN CHECK DOKU

EXCEPTION DOCUMENTS
DOCUMENTS
KTP / KITAS / Passport SIUP / Certicate of Residence Tax Identication Number (NPWP) Deed of Establishment & the Changes Lembar Pengesahan Men-Kehakiman Rental or Lease Agreement / Contract / Ownership Merchant Request Form Sites Photo (front view, store signage, o ce view) Payment Account (Bank, Branch, Account No.) EXCEPT for Merchant that located in representatif Malls (NON ITC) Priority BANKs Saving Account

EXCEPTION

INFORMATION
Exchange with Surat Pernyataan Pengurusan from Merchant (sign by Merchant & Stamp/Materai). Exchange with Surat Pernyataan Pengurusan from Merchant (sign by Merchant & Stamp/Materai). Exchange with Surat Pernyataan Pengurusan from Merchant (sign by Merchant & Stamp/Materai). Exchange with Surat Pernyataan Pengurusan from Merchant (sign by Merchant & Stamp/Materai). Exchange with Surat Pernyataan Pengurusan from Merchant (sign by Merchant & Stamp/Materai). Exchange with explanation letter from Merchant.

*EDU : Early Detection Unit. Merchants unit/sta that check all incoming transactions for the card holder genuity.

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MERCHANT APPLICATION

APPLICATION
MERCHANT BUSINESS INFORMATION
Company Registered Name Company Trading Name NPWP No. URL Address City Ownership Type (Please circle) 1. Private Corporation 2. Partnership Place Incorporated O ce No. 3. Government 4. Education Month / Year Started Customer Service No. No. of Employees Contact Person E-Mail Address Business Premises (Please circle) 1. Owned Landlord Name 2. Rented Contact Name Contact Number Occupied since ( mm / yyyy ) Lease Expires ( mm / yyyy ) 5. Non - Prot State Postal Code

BUSINESS BACKGROUND INFORMATION

Business Type (Please circle) 1. Retail Swipe 2. Transfer Product Type (Please circle) 1. Airlines 2. Land Transportation 3. Hotel 4. Travel Agent 5. EO / Conference 6. Insurance Average Ticket Rp Expected Monthly CC Sales Rp Types of Sales (Please circle) Delivery Policy after Transaction (Please circle) Refund & Return Policy (Please circle) 1. Business to Business 2. Business to Cunsumer 1. Immediate 2. Within 24 hours 1. Immediate 2. After 14 working days 3. Wholesale 4. Distributor 3. 1-3 days 4. 4-7 days 3. After 30 working days 4. Others 7 . MLM / Subscription 8 . ISP 9 . Advertisement 10. Digital Content 11. Electronics 12. Retail Minimum Ticket Rp 13. Property 14. Education 15. Government 16. Charity / Donation 17. Exports 18. Others : Maximum Ticket Rp 3. Mail Order & Telephone Order 4. Internet 5. Other

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MERCHANT SERVER

APPLICATION (SECTION 1) ( FOR MERCHANT WITH EXISTING MALL/WEB SERVER )

WEB SERVER INFOMATION
Website URL :

Website hosted in A. Indonesia. City : Type of hosting A. Shared Server Hosting Company Name : B. Dedicated Server C. Co-location ISP Company used for Web Server : B. Foreign. Country :

Server Platform : A. Windows Language Used : A. PHP Database Used : A. MySQL SSL Certicate used: A. Verisign Shopping Cart used: A. OSCommerce B. VirtueMart C. In-House D. Other B. Thawte C. None D. Other B. MSSQL C. Postgresql D. Other B. ASP/.NET C. Java D. Other B. Linux C. FreeBSD D. Other

WEB DEVELOPER INFORMATION

Website Development A. In-House IT IT Contact : Name E-Mail Phone IM : : : : B. 3rd Party. Company Name :

*For Merchant without Mall / Web Server(s), DOKU would like to o er or assist you with a solution. Please Contact us.

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FEES

Application (Section 2)
1. ACQUIRING BANKS & BRANDS
CREDIT CARD BNI CITIBANK MANDIRI VISA / MasterCard VISA / MasterCard VISA / MasterCard MDR PAY PAL T-CASH E-MONEY OTHERS RATES

2. DOKU SERVICES
A. Registration + Account Application (non-refundable) B. Setup Fee (Integration) C. Monthly Getaway Subscription D. Transaction Fee VISA / MasterCard : Rp. 2.000.000,00 : Rp. : Rp. : Rp.

Billing Terms and Conditions: - Minimum Contact Terms : 24 Months from the activation date of MID/TID issued by BANKS and/or DOKU - A & B are payable after signing the application from - C is application throughout the duration of the contract with no exceptions unless agreed by DOKU management - Penalty for late payment and early termination of contract will apply as per Clause 3 "Biaya" in the Merchant Agreement This Application should be read together with the Terms and Conditions found in the Merchant Agreement. The Merchant agrees to be bound by the Terms and Conditions incoperated by reference herein and attached hereto. This Application shall only modied or amended in writing signed by the authorized representative of both parties. This Application and attached Merchant Agreement supersedes any representation, promised, proposals and communication (oral & writen) and prevails over any additional or conicting terms contained within any purchase order, invoice of other similar document for these Services.

Name of Authorized Signatory :

Signature of Applicant / Authorized Signatory

DOKU Authorized O cer

Merchant Company Stamp (if applicable) Date : Date :

DOKU Company Stamp

For Doku Use Only

Sales Manager :

For Sales Exec and Reseller Use Only

Sales Executive / Reseller Name : Signature / Companys Signature : (If applicable)

Managers Signature :

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