Form Number: SNT-FR-PR-002

Merchant Application Form Version: 1.1

Date: 1st October 2021

SUBMITTED BY (agent): SNT OFFICE USE

Received Date Stamp
MERCHANT NAME: MASTURA BINTI ANYAN

MERCHANT TIER (√):

 Tier 1 – Micro Merchant (e.g Petty Traders, Hawkers)
 Tier 2 – SME Merchant
 Sole Proprietor / Partnership
 Sdn Bhd / Bhd
 Religious, Non-Profit Organisation
 Government
 Tier 3 – Enterprise Merchant □ Branch
 Sdn Bhd / Bhd with POS/Web/App integration
Merchant ID: M10081592
ECS Username:
Please arrange your documents as below upon submission.
Items Checklist (√)
MICRO MERCHANT
a) Merchant Application Form
b) Customer Due Diligence Form (filled by recruiter)
c) Personal Bank Statement / Instant Bank Transfer Receipt
d) Owner NRIC photocopy (front & back)
e) Municipal Council / Hawker License
f) Screenshot of Merchant Info Page that shows Merchant ID
g) Business Stall Photos
SOLE PROPRIETOR / ENTERPRISE / SDN BHD / BHD
a) Merchant Application Form
b) Customer Due Diligence Form (filled by recruiter)
c) Latest Company Bank Statement Header (with business address)
d) NRIC photocopy of Owner / Director (front & back)
- For Sole Proprietor / Enterprise, NRIC photocopies of all owners
- For Sdn Bhd / Bhd, NRIC of authorized director (signatory)
e) Business Documents (valid documents)
- For Sole Proprietor / Enterprise, - For Sdn Bhd / Bhd,
1. Extract of Registration Business Name 1. Form 49 / latest SSM Particulars of Directors / Officers
2. Sijil Pendaftaran 2. Form 9 or Section 17
3. Trade License 3. Trade License
4. Latest SSM Summary of Financial Information

f) Business Premise Photo (with signage)

Religious / Non-Profit Organisation
a) Merchant Application Form
b) Customer Due Diligence Form (filled by recruiter)
c) Latest Bank Statement header with business address
d) NRIC photocopy of Signatory (Chairman, President, General Secretary or Treasurer)
e) Form 3 - Registration From ROS (Akta Pertubuhan 1966)
f) List of committee members / Office bearers with Letter Head and stamp
g) Premise Photo
Government
a) Merchant Application Form
b) Customer Due Diligence Form (filled by recruiter)
c) Latest Bank Statement header with business address
d) NRIC photocopy of Director (signatory)
e) NRIC photocopy of Contact Person
f) Letter of Request

Remarks:

Page: 1 of 2
 Form Number: SNT-FR-PR-002
Merchant Application Form Version: 1.1
Date: 1st October 2021

Please complete this form in FULL to apply for S PAY GLOBAL Merchant Service.
1. MERCHANT DETAILS
Registration Name (Business / Agency / Preferred QRC Name (Business Name):
Entity / Government) AZZAMAMMAR ENTERPRISE
AZZAMAMMAR ENTERPRISE
Name of Food Court/Coffeeshop/ Market Registration No:
FOOD COURT TJM/BNR/076/2023
(Tier 1 only) Trade License Expiry Date: 6 NOVEMBER 2025
Business / Trading Address Tel:
KAMPUNG BARU RAJANG,96150 SARAWk
Fax: 0137012747
Nature of Business Integration (If Applicable):
(Please describe in detail)  Point of Sale  Website URL  App

MENJUAL MAKANAN DAN MINUMAN Software Developer Name & Tel:

2. BUSINESS OWNER / AUTHORISED PERSON IN CHARGE

Owner / PIC Name MASTURA BINTI ANYAN
NRIC Number: 981105135800
Designation BOS
Contact Number: 0137012747
S PAY GLOBAL Username (Tier 1 only) masturaanyan
Email: [email protected]

3. BANK DETAILS FOR CREDITING OF PAYMENTS

* Note: The timing of settlement to be reflected in your bank account is T+1 Working Day.
Bank Name MAYBANK
Account Number: 011177162791
Bank Account Holder Name Email (for notification):
MASTURA BINTI ANYAN [email protected]

4. MERCHANT SERVICE FEE – MERCHANT DISCOUNT RATE (MDR)

*If applicable, standard rate of 1% may apply
MDR (The MDR shall be the rate
____ % of Transaction Amount
indicated and accepted by the Merchant)
Confirmation by Merchant/Third Party Merchant Acquirer (Please tick [√] to confirm)
[ ] I/We hereby accept the above service fee and that SiliconNet Technologies Sdn Bhd reserves the right to revise the said service fee by giving 90
days written notice.

5. ACKNOWLEDGEMENT AND DECLARATION (Please tick [√] to confirm)

[ ] I declare that all information and documents provided herein are true and complete to my knowledge and agree to provide written notice
and additional documents upon request to SiliconNet Technologies Sdn Bhd (SNT) on any changes of information as bound by this application.
[ ] By submitting this Application Form, I acknowledge that I have read and fully understood the S PAY GLOBAL Business Terms and Conditions
available at https://spayglobal.my/ and agree to be bound by these Terms and Conditions.

Company / Business Stamp Applicant’s Signature Name: MASTURA BINTI ANYAN

(Owner/Partner/Director) Designation: BOS
NRIC Number: 981105135800
Mobile Number: 0137012747
Date: 17/2/2025

AGENT/AGENCY SUBMITTED AND DECLARATION

I declare that Agent’s Signature/Name and ID Agency Manager’s Signature/Name and ID
1. the information provided in this form is true and correct.
2. the original documents are sighted by me.
3. the necessary CDD checks according to SNT’s
requirements have been conducted.
Date: Date:

FOR SNT OFFICE USE ONLY

Submitted by Staff Remarks

Name/Signature/Date
Checked & Verified by: Recommended by: Approved / Rejected by:

Name/Signature/Date Name/Signature/Date Name/Signature/Date

Page: 2 of 2