GTBank USSD Merchant Registration Form
Uploaded by
giftajoku2011GTBank USSD Merchant Registration Form
Uploaded by
giftajoku2011Guaranty Trust Bank Ltd Guaranty Trust Bank Ltd
USSD MERCHANT REGISTRATION FORM
In Collaboration with
SECTION 1 - COMPANY INFORMATION
ACCOUNT NAME
TRADING NAME (If different from Account Name)
ACCOUNT NUMBER (for settlement of transactions): RC NUMBER
ADDRESS:
BUSINESS SEGMENT/INDUSTRY
Stores/Supermarket Restaurants Wholesale Telecoms
Fuel Stations Fast Food Hotels/Guest House Logistics (Courier)
Church/NGOAgencies) Hospital Airline (Operators) Airline (Travel
Others (Specify)
Number of cashiercodes required: kindly go to section 3 to fill in the information for each cashier.
SECTION 2 - CONTACT INFORMATION
This section gathers information about the contact person in your organization. All correspondence
between Bank and your organization will be addressed to the person(s) below:
NAME OF PRIMARY CONTACT PERSON: NAME OF SECONDARY CONTACT PERSON
DESIGNATION: DESIGNATION:
OFFICE TELEPHONE/EXTENSION OFFICE TELEPHONE/EXTENSION
MOBILE PHONE NO: MOBILE PHONE NO:
E-MAIL ADDRESS: E-MAIL ADDRESS:
I, on behalf of hereby certify that the information
provided in this form is true and accurate. I agree that Guaranty Trust Bank Ltd. reserve the right to take appro-
priate measure including legal action if the information here is discovered to be false. I agree with the terms and
conditions in the GTBank Merchant Agreement form.
Signature Designation Date
SECTION 3 - CASHIER INFORMATION
This section gathers information about merchants that require more than one Checkout Code (CC). Transaction
receipt will be sent via sms to the phone number and email assigned to the cashier operating the checkout code.
Transaction reports will be made available using the information provided.
Merchant Name:
Note: Kindly fill in the information in clear and legible writing. A duplicate copy of this sheet can be made
if the merchant requests more than 25 cashiercodes. Compulsory fields have been asterisked.
CC FIRST NAME/ALIAS LOCATION OF CASHIER* GSM NUMBER* EMAIL ADDRESS Settlement Account*
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FOR OFFICIAL USE:
SECTION 4: To be completed by Account Officer
ACCOUNT OFFICER NAME:
BRANCH GROUP/DIVISION
PC CODE TEAM EMAIL
Is KYC (Know Your Customer) in place? Yes No
Does customer have any record(s) of fraudulent transactions Yes No
Unit Head/Group Head Remark & Signature Date
Section 6: TO BE COMPLETED BY E-PAYMENT SOLUTION GROUP
Merchant Type
USSD Service Code
Merchant Code