Vendor Registration Form

(Marked * : Mandatory Fields)

Entity Name (Use dropdown for response)* Phonepe Private Limited
If selected Multiple Entities NA
Type of Services*
(Use dropdown for response) Others
If Others selected above, please detail Consultancy/ Digital Services/ERP
Nature of Business*
(Use dropdown for response) Service Provider
If Others selected above, please detail As Per GST/Business Proof Shared ( To be filled by the Vendor )
Vendor Name* As Per GST/Business Proof Shared ( To be filled by the Vendor )
Contact Person* Name of the Vendor Partner
Address* As Per GST/Business Proof Shared ( To be filled by the Vendor )
Street As Per GST/Business Proof Shared ( To be filled by the Vendor )
City As Per GST/Business Proof Shared ( To be filled by the Vendor )
State As Per GST/Business Proof Shared ( To be filled by the Vendor )
Country As Per GST/Business Proof Shared ( To be filled by the Vendor )
Postal code* As Per GST/Business Proof Shared ( To be filled by the Vendor )
Telephone
Fax
Mobile* As Per GST/Business Proof Shared ( To be filled by the Vendor )
GST Reg. or Non-GST Declared*
(Use dropdown for response)
Pan No* Business PAN Card Number
E-mail* Vendor Email ID for all communications with PhonePe
Company Registration No* Applicable for PVT LTD Merchants ONLY
Micro, Small, Medium Enterprises Registration No.
(MSME) or Non-MSME Declaration* MSME Registration Number, if Applicable
Bank - Details
Account Holder Name* As per Bank Proof Shared - To be filled by the Vendor
Name of Bank As per Bank Proof Shared - To be filled by the Vendor
Branch As per Bank Proof Shared - To be filled by the Vendor
Account No* As per Bank Proof Shared - To be filled by the Vendor
IFSC code* As per Bank Proof Shared - To be filled by the Vendor
Swift code(Mandatory for International Vendor) NA
Conflict Of Interest Mandatory Declaration : The objective of this declaration is to ascertain any Yes
situation(s) that might create or could create, a conflict of interest. Our expectations are that you make a
declaration as per best of your knowledge and notify to the Phonepe by signing the COI declaration which
will be provided as an attachment by Phonepe team during vendor registration process.
Please select 'Yes' in the following section post signing the COI declaration .

Third Party Intermediary Declaration

Is the Supplier a Third Party Intermediary (TPI) as defined below:*
(Use drop down for response) : No
If the Supplier is a TPI, does the Supplier agreement include an Anti-Corruption clause:*
(Use drop down for response) : No
Third Party Intermediary (TPI): A “Third Party Intermediary” (“TPI”) is a service provider, consultant, distributor, contractor, vendor, supplier, or other third
party, whether an individual or an entity, other than a Business Partner, engaged or retained to assist the Company in any function or business that requires
or involves interaction with any Government Entity or Government Official on behalf of the Company. A supplier of only goods is not a TPI.
Note: Please get in touch with the Anti Corruption Team for any queries regarding TPI assessment.

Service Type Based Information

Type of Category* Domestic Non-Category Vendors
Purchase/Service Order or Agreement Based* Agreement
If selected 'None of the above', please mention
order amount NA
Phonepe Business Unit SPOC details*
Employee Name* Has to be filled by the ISE Post the form has been shared by the Vendor
Email Id* Has to be filled by the ISE Post the form has been shared by the Vendor
Contact details* Has to be filled by the ISE Post the form has been shared by the Vendor
Approver Name*(Manager & above) Has to be filled by the ISE Post the form has been shared by the Vendor
Unit/Department* Has to be filled by the ISE Post the form has been shared by the Vendor
Email ID* Has to be filled by the ISE Post the form has been shared by the Vendor
Contact details* Has to be filled by the ISE Post the form has been shared by the Vendor
 Phonepe Internal Business Unit SPOC Signatory*

Phonepe Internal Business Unit Manager Signatory*

Supplier Authorized Seal & Signatory*

Supplier Authorized Seal & Signatory

For any clarification feel free to contact - Vendormagt@phonepe.com

Vendor should raise the invoice only after PO/Contract is signed and shared with vendor and the date of invoice should always be after the
PO/contract date