DOKU Form Rev2

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 Authorized Signatory DOKU Authorized Signatory

INTERNET BANKING DOKU

Nama Perusahaan

Alamat Perusahaan

Nomor Telephone Nomor Fax Website

Jenis Usaha

Penerbangan Elektronik Donasi Lain-lain : ____________________

Tour / Travel Retail MLM

A. DATA BISNIS MERCHANT

LEMBAR PERSETUJUAN LAYANAN PEMBAYARAN INTERNET BANKING DOKU

No PKS DOKU : Jangka Waktu :

INTERNET BANKING

KlikBCA Others :

MANDIRI

BIAYA DOKU BANK’s

Transaksi : Rp.

Tanggal Perjanjian : Jangka Waktu :

B. DATA LAYANAN

C. PELAKSANAAN BISNIS

www.doku.com

merchant logo

MERCHANT DOCUMENT

KTP / KITAS / Passport

SIUP / Certificate of Residence

Tax Identification Number (NPWP)

Deed of Establishment & the Changes

Lembar Pengesahan Men-Kehakiman

Rental or Lease Agreement / Contract / Ownership

Merchant Request Form

Site’s 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 & Travel’s Merchants SP Debet for merchant HP, Jewellery, Computers

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

DOCUMENTS INDIVIDUAL,PD,UD PT, CV, FIRMA,YAYASAN CHECK DOKU

LEGAL DOCUMENTS

EXCEPTION DOCUMENTS

www.doku.compage 1 of 2

KTP / KITAS / Passport

SIUP / Certificate of Residence

Tax Identification Number (NPWP)

Deed of Establishment & the Changes

Lembar Pengesahan Men-Kehakiman

Rental or Lease Agreement / Contract / Ownership

Merchant Request Form

Site’s Photo (front view, store signage, o�ce view)

Payment Account (Bank, Branch, Account No.)

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





Exchange with explanation letter from Merchant.

EXCEPT for Merchant that located in representatifMalls (NON ITC)

Priority BANK’s Saving Account

DOCUMENTS EXCEPTION INFORMATION

MERCHANT APPLICATION

Company Registered Name Company Trading Name NPWP No.

URL

Address

City State Postal Code

Ownership Type (Please circle)

1. Private Corporation 3. Government 5. Non - Profit

2. Partnership 4. Education

Place Incorporated Month / Year Started No. of Employees

O�ce No. Customer Service No. Contact Person

E-Mail Address

Business Premises (Please circle) Occupied since ( mm / yyyy ) Lease Expires ( mm / yyyy )

1. Owned 2. Rented

Landlord Name Contact Name Contact Number

MERCHANT BUSINESS INFORMATION

APPLICATION


Business Type (Please circle)

1. Retail Swipe 3. Mail Order & Telephone Order 5. Other

2. Transfer 4. Internet

Product Type (Please circle)

1. Airlines 7 . MLM / Subscription 13. Property

2. Land Transportation 8 . ISP 14. Education

3. Hotel 9 . Advertisement 15. Government

4. Travel Agent 10. Digital Content 16. Charity / Donation

5. EO / Conference 11. Electronics 17. Exports

6. Insurance 12. Retail 18. Others :

Average Ticket Minimum Ticket Maximum Ticket

Rp Rp Rp

Expected Monthly CC Sales

Rp

Types of Sales 1. Business to Business 3. Wholesale

(Please circle) 2. Business to Cunsumer 4. Distributor

Delivery Policy after Transaction 1. Immediate 3. 1-3 days

(Please circle) 2. Within 24 hours 4. 4-7 days

Refund & Return Policy 1. Immediate 3. After 30 working days

(Please circle) 2. After 14 working days 4. Others

BUSINESS BACKGROUND INFORMATION

Website URL :

Website hosted in

A. Indonesia. City : B. Foreign. Country :

Type of hosting

A. Shared Server B. Dedicated Server C. Co-location

Hosting Company Name : ISP Company used for Web Server :

Server Platform :

A. Windows B. Linux C. FreeBSD D. Other

Language Used :

A. PHP B. ASP/.NET C. Java D. Other

Database Used :

A. MySQL B. MSSQL C. Postgresql D. Other

SSL Certificate used:

A. Verisign B. Thawte C. None D. Other

Shopping Cart used:

A. OSCommerce B. VirtueMart C. In-House D. Other

Website Development

A. In-House IT B. 3rd Party. Company Name :

IT Contact :

Name :

E-Mail :

Phone :

IM :

MERCHANT SERVER

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

WEB SERVER INFOMATION

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


WEB DEVELOPER INFORMATION

CREDIT CARD MDR OTHERS RATES

BNI VISA / MasterCard PAY PAL

CITIBANK VISA / MasterCard T-CASH

MANDIRI VISA / MasterCard E-MONEY

A. Registration + Account Application (non-refundable) : Rp. 2.000.000,00

B. Setup Fee (Integration) : Rp.

C. Monthly Getaway Subscription : Rp.

D. Transaction Fee VISA / MasterCard : 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 modified 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 conflicting terms contained within any purchase order, invoice of other similar document for these Services.

FEES

1. ACQUIRING BANKS & BRANDS

2. DOKU SERVICES

Application (Section 2)


Name of Authorized Signatory :

Signature of Applicant / Authorized Signatory DOKU Authorized O�cer

Merchant Company Stamp(if applicable) DOKU Company Stamp

Date : Date :

Sales Manager :

Manager’sSignature :

Sales Executive /Reseller Name :

Signature /Company’sSignature :

(If applicable)

For Doku Use Only For Sales Exec and Reseller Use Only

DOKU Form Rev2

Documents

Transcript of DOKU Form Rev2