Merchant Application Form for PG
Sequence number: 12022025140034 MID:
Subject: Merchant Application Form and Terms and Conditions for NDPS Services for payment acceptance & or Value Added Services.
This Merchant Application Form is hereby agreed to by the undersigned Parties and who do hereby agree to the terms and conditions hereinafter appearing.
Merchant Legal Name: SRI KRISHNASAMY REDDIAR EDUCATIONAL TRUST
By and Between
NTT Data Payment Services India Private Limited (formerly known as NTT Business DBA (Brand Name): SRI KRISHNASAMY REDDIAR EDUCATIONAL TRUST
DATA Payment Services India Limited) (“NDPS”)
Add: 4th Floor, Marchon, 401, Suraksha Ace, Plot No.2A, CTS. No.34/3,
AND Business Registered Address: No 1, NELLIKUPPAM MAIN ROAD
Andheri - Kurla Road, Village Chakala, J.B. Nagar, Andheri East, Mumbai
Suburban, Maharashtra, 400059
City: Cuddalore State: TamilNadu Pin: 6 0 7 1 0 9
1) Merchant Application Details :
A) Business Details
Authorized Contact Person Name (First/Last Name) RAJENDRAN K
Authorized Contact Person Mobile number 9442867198
Authorized Contact Person WhatsApp Mobile Number 9442867198
Authorized Contact Person Landline 04142-285601
Authorized Contact Person Email
[email protected]Business Operating Address Same as Business Registered Address Different - Address:
Source (filled by NDPS) Bank
Name of Source (if applicable ) Canara Bank
Business Industry E-com
Business Model (B2B / B2C ) BUSINESS TO BUSINESS BUSINESS TO CUSTOMER
Nature of Business (mention specific purpose of business ) Education
Detail about Business (specific service/s & product/s ) Trust
Entity Type
GST Identification Number (15 Characters) 3 3 A A C T S 7 1 2 6 H 1 Z J
Business Legal Name as per PAN/TAN
PAN / TAN Number (10 Characters) A A C T S 7 1 2 6H
Business Registration Date 0 1 0 4 2 0 1 8
Affiliation Number (*applicable for education industry ) AU-CDC/23/2024
Company Annual Turnover (INR in Lac)
Average ticket size for Single Transaction (approximate ) ( INR)
B) Integration / Technical Details
Transaction Domain URL / IP Address (If applicable )
*Seamless / Non-Seamless (*check with Transaction System Provider ) Seamless (Show Merchant Payment Page) Non-Seamless (Show NDPS Payment Page)
Domain URL and IP Address (Confirm with TSP/Source) xxx.xxx.xxx.xxx
Type of Integration Website https://kcsam.in
Mobile Application Name / Application link (if applicable )
Mobile Application is available in (if applicable ) Android iOS Other App *Other App Name
Transaction System is provided by Third Party Yes No
Transaction System Provide/ Company Name: iCLIENT TECH
If above is Yes, please provide the following Contact Person (First/Last Name):Thiyagarajan
Contact Number 9500438555
Email ID: [email protected]
C) Merchant Settlement Bank Account Details
Beneficiary Bank Name INDIAN OVERSEAS BANK
Beneficiary Bank Branch Name KUMARAPURAM, CUDDALORE
Beneficiary Account Name KRISHNASAMY COLLEGE OF ARTS AND SCIENCE
Beneficiary Mobile Number Registered with Bank Account 9442867198
Beneficiary Account Number 1 8 2 4 0 2 0 0 0 0 0 0 0 5 4
Beneficiary IFSC Code (11 digit) I O B A 0 0 0 1 8 2 4
D) Merchant Account VPA Details
Standing Instruction to Debit
("Merchant/Seller authorises NDPS to deduct any recoverable amounts such as
Rent/AMC/Fee/disputes etc., from this VPA / Bank Account toward recovery of any
outstanding dues." )
Cancel Cheque : pertaining to the Settlement account details mentioned above in section “C”.
NOTE:- Merchant/Seller hereby in this Application Form authorizes NDPS to communicate (integration kit, encrypted production credentials , technical and non-technical post-production
notifications, and any other notification / communication) vide email (and or auto-generated email) and / or WhatsApp to the contact details mentioned above in the section A of Merchant
Application Form. In case the Source is ERP/Tech partner, then, the encrypted production credentials will be communicated to the partner as well.
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