4/22/2021 Simple KYC

New Zealand Digital Merchant Application

Merchant Details
Merchant Rate is 2.65%
Full Legal Entity Name OTAGO FOODLAND LIMITED
NZCN (New Zealand Company Number) 8168181
NZBN (New Zealand Business Number) 9429049122213
Business Entity Type NZ Limited Company
Trading name VEGGIE BOYS ND
Industry / Nature of Business SHOPS-FOOD FRUIT GROCERY
If Affiliated, Name of Chain or Franchise Group N/A
Store/Location ID N/A
Business Phone Number NZ 0210 382 258
Physical Address (No PO Boxes) 110 ALBANY STREET NORTH DUNEDIN DUNEDIN 9016 New Zealand
Postal Address 110 ALBANY STREET NORTH DUNEDIN DUNEDIN 9016 New Zealand
NZ Company Number / Charity 8168181
Country of Incorporation New Zealand
Incorporation/Registration Date 11/03/2021
Association/Club/Society state legal status and purpose N/A
Are you registered for GST? Yes
GST Number 133-669-787
Select GST Supply Type Fully Taxed
Registered Address 23 Tower Avenue WAVERLEY DUNEDIN 9013 New Zealand
Email Address otagofoodlandltd@gmail.com
Please Tick here to enrol for "My Merchant Account" to view your statements and manage your account online Checked
(the email address above will be used)
Please tick here to receive email messages including marketing offers, information on products, services and Unchecked
resources available to your business

Submission & Bank Details

Terminal Type EFTPOS

EFTPOS Terminal Details

Provider Paymark
Bank Merchant Number 10474415
Number of Terminals 2
Terminal ID 47441501 Terminal ID 47441502

Bank Details
Bank Name ANZ
Bank Account Name OTAGO FOODLAND LTD
Account Number 060901077254501

Direct Debit Authority

Merchant Name N/A
Merchant Number N/A
Information is the same as the Bank Details Checked
Name of Bank Account OTAGO FOODLAND LTD
Bank account from which payments are to be made 060901077254501
By nominating the bank account above, you are providing American Express your agreement to direct debit your account for funds owing to American Express
including your monthly merchant service fees, subject to the terms and conditions in the Direct Debit Request Service Agreement.

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Beneficial Owners
Beneficial Owner 1
Shareholder
Are any shares in the ownership structure held on behalf of No
a trust/entity/individual (i.e. nominee bearer form)?
Full Name Supreet SINGH
Job Title / Position Director & Shareholder
Date of Birth (DD/MM/YYYY) 31/05/1985
Ownership % of the Entity 50.00
Driver’s Licence No DO855366
Version No. 415
Passport Number N/A
Passport Expiry Date N/A
Residential Address (No PO Boxes) 23 TOWER AVENUE WAVERLEY DUNEDIN 9013 New Zealand

Beneficial Owner 2
Shareholder
Are any shares in the ownership structure held on behalf of No
a trust/entity/individual (i.e. nominee bearer form)?
Full Name Parvesh KUMAR
Job Title / Position Director & Shareholder
Date of Birth (DD/MM/YYYY) 20/05/1987
Ownership % of the Entity 50.00
Driver’s Licence No DS887147
Version No. 411
Passport Number N/A
Passport Expiry Date N/A
Residential Address (No PO Boxes) 72 CRANLEY STREET SAINT KILDA DUNEDIN 9012 New Zealand

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Directors
Director 1
Full Name Supreet SINGH
Job Title / Position Director & Shareholder
Date of Birth (DD/MM/YYYY) 31/05/1985
Driver’s Licence No DO855366
Version No. 415
Passport Number N/A
Passport Expiry Date N/A
Residential Address (No PO Boxes) 23 TOWER AVENUE WAVERLEY DUNEDIN 9013 New Zealand

Director 2
Full Name Parvesh KUMAR
Job Title / Position Director & Shareholder
Date of Birth (DD/MM/YYYY) 20/05/1987
Driver’s Licence No DS887147
Version No. 411
Passport Number N/A
Passport Expiry Date N/A
Residential Address (No PO Boxes) 72 CRANLEY STREET SAINT KILDA DUNEDIN 9012 New Zealand

Other Business Locations

Number Of Locations N/A

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Authorised Signatories
Authorised Signatory 1
Full Name Supreet SINGH
Job Title / Position Director & Shareholder
Contact Number NZ
Date of Birth (DD/MM/YYYY) 31/05/1985
Driver’s Licence Number DO855366
Version Number 415
Residential Address (No PO Boxes) 23 TOWER AVENUE WAVERLEY DUNEDIN 9013 New Zealand

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Signature
By checking this box you are confirming that you have read the terms and conditions of the American Express Checked
Merchant Agreement and the International Merchant Regulations available online at
www.americanexpress.com/InternationalRegs as amended from time to time (collectively, “Terms”) and you
agree that you will be subject to and bound by the Terms.

Declaration and Signature

Full Name of Authorised Signatory Supreet SINGH
Position / Title Director
Generate a Signature for Me Checked
Signature of Authorised Signatory

Date (DD/MM/YYYY) 23/04/2021

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Privacy
1. American Express Customer Privacy Principles

American Express Australia Limited (American Express) are proud of their reputation for, and commitment to, safeguarding information about
their customers. The American Express Data Protection and Privacy Principles have been in place for many years and provide a minimum
worldwide standard to which all of American Express agrees to comply with. In addition, American Express will comply with the requirements of
the Privacy Act 1988 (including the Australian Privacy Principles)

2. Authority to American Express under the Privacy Act:

To assess your application, and if it is approved, to establish the merchant card acceptance facility, American Express needs to:

collect personal information about the individuals directly associated with the business, and

obtain the individuals’ agreement in relation to handling this personal information.

If the business does not provide the information requested or give their agreement, American Express may not be able to provide
them with the Merchant Card acceptance facility service.

The American Express Privacy Policy Statement sets out policies on management of personal information. In accordance with the
Privacy Act, an individual can access personal information held about them by American Express and advise if they think it is
inaccurate, incomplete or out of date.

An individual may arrange access to personal information about them held by American Express, request a copy of the American
Express Privacy Policy Statement or inquire generally about privacy matters by writing to – The Privacy Officer, American Express
Australia Limited, GPO Box 1582, Sydney NSW 2001.

In this section ‘personal information’ means information about an individual directly associated with the business, including about their financial
circumstances and their use and conduct of the merchant card acceptance service.
You agree that, subject to the Privacy Act, American Express and their agents may do the following:

Obtain commercial credit worthiness information from credit reporting agencies to assess your application.

Exchange information about you with other providers of card merchant acceptance facilities and their associated providers (including VISA
and MasterCard) for the purposes of fraud prevention.

Exchange personal information with any person whose name you give us from time to time. This includes, for example, for the purpose of
confirming your financial information with any financial institution, landlord/mortgagee, accountant, financial adviser or tax agent.

Exchange personal information with third parties for the purposes of conducting an Information Match Request using the Commonwealth
of Australia Document Verification Service to obtain an Information Match Result in relation to personal information which you have
provided to us.

Use personal information for marketing purposes. This may include putting your name and contact details on marketing lists for the
purposes of customer research and offering goods or services of an American Express company or any third party acting on behalf of
American Express, by mail, email or telephone or having your related companies do so directly. You understand that you can call 1300 363
614 to remove your name from your marketing lists.

Transfer personal information confidentially to American Express’ related companies and other organisations which issue or service
American Express cards or provide services to American Express, subject to appropriate conditions of confidentiality. This includes
transferring personal information to the United States or other countries for data processing and servicing.

Monitor and record telephone conversations with American Express from time to time for training, quality control or verification purposes.
Where you have provided American Express with information about an individual in the application form, you agree to make sure that the
individual is aware of:

You supplying the information about the individual to American Express for the purposes of establishing the merchant card acceptance
service.

Their ability to access the information in accordance with the Privacy Act.

The contact details of American Express’ Privacy Officer, and

Full ‘Terms for Direct Debit Service Addendum’

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Conditions of this authority to accept Direct Debits

1. The Initiator:
a) Has agreed to give advance notice of the net amount of each Direct Debit and the due date of the debiting at least 10 calendar days
(but not more than 2 calendar months) before the date when the Direct Debit will be initiated. This notice will be provided in writing
(including by electronic means and SMS where the Customer has provided prior written consent (including by electronic means
including SMS) to communicate electronically). The advance notice will include the following message: “Unless advice to the contrary
is received from you by (date*), the amount of $.......... will be Direct Debited to your Bank account on (initiating date).”

*This date will be at least two (2) days prior to the initiating date to allow for amendment of Direct Debits.

b) May, upon the relationship which gave rise to this Authority being terminated, give notice to the Bank that no further Direct Debits are
to be initiated under the Authority. Upon receipt of such notice the Bank may terminate this Authority as to future payments by notice
in writing to me/us.

c) May, upon receiving written notice (dated after the date of this Authority) from a bank to which I/we have transferred my/our account,
initiate Direct Debits in reliance of that written notice and this Authority from the account identified in the written notice.

2. The Customer may:

a) At any time, terminate this Authority as to future payments by giving written notice of termination to the Bank and to the Initiator.

b) Stop payment of any Direct Debit to be initiated under this Authority by the Initiator by giving written notice to the Bank prior to the
Direct Debit being paid by the Bank

3. The Customer acknowledges that:

a) This Authority will remain in full force and effect in respect of all Direct Debits passed to my/our account in good faith notwithstanding
my/our death, bankruptcy or other revocation of this Authority until actual notice of such event is received by the Bank.

b) In any event this Authority is subject to any arrangement now or hereafter existing between me/us and the Bank in relation to my/our
account.

c) Any dispute as to the correctness or validity of an amount debited to my/our account shall not be the concern of the Bank except in
so far as the Direct Debit has not been paid in accordance with this Authority. Any other dispute lies between me/us and the Initiator.

d) Where the Bank has used reasonable care and skill in acting in accordance with this Authority, the Bank accepts no responsibility or
liability in respect of:

The accuracy of information about Direct Debits on Bank statements; and

Any variations between notices given by the Initiator and the amounts of Direct Debits.

e) The Bank is not responsible for, or under any liability in respect of the Initiator’s failure to give notice in accordance with 1(a) nor for
the non-receipt or late receipt of notice by me/us for any reason whatsoever. In any such situation the dispute lies between me/us
and the Initiator.

4. The Bank may;

a) In its absolute discretion conclusively determine the order of priority of payment by it of any monies pursuant to this or any other
authority, cheque or draft properly signed by me/us and given to or drawn on the Bank.

b) At any time terminate this Authority as to future payments by notice in writing to me/us.

c) Charge its current fees for this service in force from time-to-time.

These terms and conditions are Payments NZ Limited approved and are non-negotiable

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