Merchant Application Form

Please fill in all the blank spaces

1. ORGANIZATION PROFILE

Organization Name:
2. Owner/Director Details (where applicable)

NAME ID NUMBER PIN NUMBER MOBILE EMAIL ADDRESS

NUMBER

3. Business Details
Physical Location
P.O. Box Number Postal Code City /Town
Street / Road County
Email Address
Outlet Mobile No. Official Line
VAT Number KRA PIN
Nature of Business (Partnership/Sole proprietor/Company/NGO/ Others)

Vooma Till Number Vooma Paybill Number Aggregated Paybill Number

Type of Business e.g. bar, salon, restaurant, others
The following documents are required to process your application. Kindly attach copies of:

National ID Yes No Business PIN Yes No Certificate of Registration Yes No

Business Permit Yes No

4. Payment Details: Bank Account Details
Name of Bank
Account name
Account number
PAP 1279: VOOMA MERCHANT APPLICATION FORM (FEB 2020)

Branch name
5. Settlement type

On demand End of day Real time settlement

6. Please Indicate the Till Mobile Number and email address for receiving payments alerts

Phone Number Email address

7. Contact Details

Name of Contact person ID TYPE ID NUMBER MOBILE NUMBER EMAIL ADDRESS

Name of Finance contact ID TYPE ID NUMBER MOBILE NUMBER EMAIL ADDRESS

Name of Administrator
ID TYPE ID NUMBER MOBILE NUMBER EMAIL ADDRESS
(Min Two)

1.

2.

Regulated by the Central Bank of Kenya

Merchant Application Form
Please fill in all the blank spaces

9. Merchant Declaration

I/We wish to subscribe to VOOMA and to automatically be enrolled to any new products, services or payment
channels that shall be offered by the Bank through VOOMA Merchant Services.

Terms & Conditions. I/We agree that the Bank shall reserve the right to approve or reject this application as the Bank
deems fit without assigning any reason. I/We have provided all the business legal documents as required by the bank and
I/We also do understand that future changes to be communicated to KCB Bank Kenya Limited, must be signed by the
authorized signatories. I/We confirm that the information I/We have provided here in and the disclosures made are true.
I/We have retrieved, read and understood VOOMA, Terms & Conditions as stipulated on https://kcbgroup.com/ which may
be amended from time to time and undertake to comply, observe and be bound by the same.

Name: Signed: Date:

Name: Signed: Date:

Name: Signed: Date:

Name: Signed: Date:

10. Official Use Only

Staff Number: Branch Name: Sales code:

Sector: Target: Customer Type: Risk Class:

Type of Business e.g. bar, salon, restaurant, Others

Customer Information Checklist

Valid Identification documents obtained & authenticated Customer’s signature obtained/captured and authenticated

Photographs obtained/captured and authenticated

11. Authorizing Official

Name & Signature Number Signature & Branch stamp

Date: Mobile Number

12. KCB Internal Use

PayBill /Till Number

Administrator’s Login Sim MSISDN allocated

Manager Login

Operator Login

Note: Information provided on this form will be used to set up the Merchant structure on the Vooma system and is subject to contract signature
Form to be returned to the Nearest KCB Branch
Existing Bank Terms and Conditions Apply

Regulated by the Central Bank of Kenya