E-Merchant Application

E-Merchant Application

This is the first application form you need to fill in to get connected to Aurea Via.
Appendix 1 to the Merchant Acquiring and Gateway Services concluded ondate, between GCCH Management FZCO, registered in Dubai, UAE under license number L-1797, and person/company name .
Company
Company
Full Company Name
Registration Number
Registration Date

MonthDayYear
Date
Legal Address
(street, house, flat, city, country, postal code)
Office Address
(street, house, flat, city, country, postal code)
Phone Number

Area CodePhone Number
Email
Company Owners

*holding 25% or more of company shares or equivalent form of individual control
Person 1
Name

First NameLast Name
Percentage Control
%
Type of Control

DirectVia Proxy
Politically Exposed Person*

YesNo
Date of Birth

MonthDayYear
Date
Nationality
Tax Residence
Taxpayer ID
Residence Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
Person 2
Name

First NameLast Name
Percentage Control
%
Type of Control

DirectVia Proxy
Politically Exposed Person*

YesNo
Date of Birth

MonthDayYear
Date
Nationality
Tax Residence
Taxpayer ID
Residence Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email

Contact Person of the Merchant
Area of Responsibility
Name

First NameLast Name
Position
Phone Number
Add country code +
Email
Contact Person of the Gateway Provider
Area of Responsibility
Name

First NameLast Name
Position
Phone Number
Add country code +
Email
Legal Representatives
E-Merchant Full Name*

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E-Merchant Full name (if applicable)*

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The Gateway Provider 1*

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The Gateway Provider 2*

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Documents to Upload
Statutory Documents

Confirming directors and beneficiaries. If country of incorporation of the company has an opened register and all the information can be found there, please provide the link.
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Proof of Bank

Proof of bank, that will confirm bank requisites of the company. It could be bank statement or reference letter or screenshot from internet-banking.
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Lease Agreement of the Company’s Office

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From Directors: Proof of Address + Passport

This must be a photo of the ID document, no scans accepted
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From Beneficiaries: Proof of Address + Passport

(This must be a photo of the ID document, no scans accepted) + CV or Linkedin
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Please note, additional information may be requested.
Please submit this form. After submission on the 'Thank You' page, you will see a button to sign the next document required.
Should be Empty:

Company