Form 1
Partner Application Form
Note: Please do not leave any fields blank. If the field does not apply to you, fill it in as “N/A.”
PRODUCT INFORMATION
Products availing of: Scan to Pay Bills Pay Online WebPay PowerPay Plus
*Check all that apply
Funds Disbursement Service Cash In / Cash Out Buy Load
GLife Remittance Rewards Others: __________
PARTNER INFORMATION
Business Structure: Sole Proprietorship Partnership Corporation
*Choose one only
Non-Goverment / Non-Profit Organization One Person Corporation
Cooperative Others:
Registered Business Name: (as indicated in your DTI/SEC/COI certificate) Trade Name: (as indicated in your BIR certificate, or your “Doing Business As”)
Business Address:
Unit No./Building Name/House No. Street Name Subdivision/Barangay
City/Municipality Region/Province Country Zip Code
Business Contact No. and Email Address:
Business TIN: (Indicate in 9 or 12 digits)
Business Channels: Number of Employees: Expected Annual Transaction
Amount:
In-Store Online Hybrid (Both)
Industry and Sub Category: (as indicated in your BIR2303 certificate)
PARTNER DECLARATION
The Partner, through its duly authorized representative, hereby certifies that all information provided herein is
true, accurate, complete, and correct and that any and all copies of the documents submitted in support of the
application are true, complete, genuine, and unaltered copies and will remain the property of G-Xchange, Inc.
(GXI). The Partner authorizes GXI to verify and investigate any information contained herein through whatever
means and/or sources it may consider appropriate. The Partner understands and agrees that falsifying or misrep-
resenting any information provided in this application or supporting documents constitutes grounds for legal
action, and/or the rejection or termination of the Partner’s application, and/or suspension of the Partner’s wallet.
The Partner shall immediately notify GXI in writing of any change to any of the information provided in this form.
By submitting this application, the Partner certifies that it understands and agrees to comply with the terms set
forth herein.
Signature over Printed Name of Business Designation: Date:
Owner/s or Authorized Representative/s:
ACCOUNT MANAGER DECLARATION
The Account Manager certifies to having checked and verified the supporting application requirements against the
original documents and found them to be authentic and in accordance with G-Xchange, Inc.'s (GXI) requirements.
Furthermore, the Account Manager acknowledges and understands that any inaccuracies, discrepancies, or falsifi-
cations in the provided information may subject the Account Manager to certain sanction or penalties, including
disciplinary sanctions in accordance with GXI's Code of Conduct for Employees.
By signing this declaration, the Account Manager acknowledges and understands that any failure to maintain these
standards may compromise the trust and operational integrity of GXI, and confirms and accepts accountability for
any errors or omissions that may arise from the submitted documentation, with such accountability extending to the
accuracy of the information at the time it is provided and to any subsequent changes or updates to such informa-
tion.
Printed Name over Signature of Account Manager: Date:
