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Form 5. SPOC Nomination Form

The document is a SPOC Nomination form for a registered business, requiring contact information for various roles including pre-funding, billing, transaction history, and partner support. It includes a partner declaration authorizing GXI to verify the provided information and outlines the consequences of misrepresentation. Additionally, there is an account manager declaration confirming the authenticity of the submitted documents and accountability for any inaccuracies.

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Michael Loquinario
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54 views

Form 5. SPOC Nomination Form

The document is a SPOC Nomination form for a registered business, requiring contact information for various roles including pre-funding, billing, transaction history, and partner support. It includes a partner declaration authorizing GXI to verify the provided information and outlines the consequences of misrepresentation. Additionally, there is an account manager declaration confirming the authenticity of the submitted documents and accountability for any inaccuracies.

Uploaded by

Michael Loquinario
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Form 5

SPOC Nomination

Registered Business Name: Trade Name: (If applicable)

CONTACT INFORMATION
Note: Please attach an additional sheet in case there are more addresses to be nominated

Primary Contact Details


Name:

Designation:

Email Address:

Tick this box if same as Primary Contact details Tick this box if same as Primary Contact details

For Pre-Funding For Billing and Collection

Name: Name:

Designation: Designation:

Email Address: Email Address:

Tick this box if same as Primary Contact details Tick this box if same as Primary Contact details

For Transaction History Reports For Partner Support Concerns

Name: Name:

Designation: Designation:

Email Address: Email Address:

Tick this box if same as Primary Contact details Tick this box if same as Primary Contact details

For Brand Reports For Settlement Report Emails

Name: Name:

Designation: Designation:

Email Address: Email Address:

Tick this box if same as Primary Contact details Tick this box if same as Primary Contact details

For LMS Nomination Others: ________________________

Name: Name:

Designation: Designation:

Email Address: Email Address:

Tick this box if same as Primary Contact details Tick this box if same as Primary Contact details

Others: ________________________ Others: ________________________

Name: Name:

Designation: Designation:

Email Address: Email Address:


PARTNER DECLARATION

The Partner authorizes GXI to verify and investigate any information contained herein through what-
ever means and/or sources it may consider appropriate. The Partner understands and agrees that
falsifying or misrepresenting any information provided in this application or supporting documents
constitutes grounds for legal action, and/or the rejection or termination of the Partner’s application,
and/or suspension of the Partner’s wallet. The Partner shall immediately notify GXI in writing of any
change to any of the information provided in this form.

By submitting this application, the Partner certifies that it understands and agrees to comply with the
terms set forth herein.

Signature over Printed Name of Business Designation: Date:


Owner/s or Authorized Representative/s:

ACCOUNT MANAGER DECLARATION

The Account Manager certifies to having checked and verified the supporting application requirements against the
original documents and found them to be authentic and in accordance with G-Xchange, Inc.'s (GXI) requirements.
Furthermore, the Account Manager acknowledges and understands that any inaccuracies, discrepancies, or falsifi-
cations in the provided information may subject the Account Manager to certain sanction or penalties, including
disciplinary sanctions in accordance with GXI's Code of Conduct for Employees.

By signing this declaration, the Account Manager acknowledges and understands that any failure to maintain these
standards may compromise the trust and operational integrity of GXI, and confirms and accepts accountability for
any errors or omissions that may arise from the submitted documentation, with such accountability extending to the
accuracy of the information at the time it is provided and to any subsequent changes or updates to such informa-
tion.

Printed Name over Signature of Account Manager: Date:

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