THTax cung cấp dịch vụ đại lý thuế, tư vấn thuế, kế toán trọn gói

Form No. 12

APPLICATION FOR AMENDMENT AND SUPPLEMENT OF THE PAYMENT INTERMEDIARY SERVICE OPERATION LICENSE

To: Governor of the State Bank of Vietnam.

Pursuant to Decree No. .../.../ND-CP dated... month... year... of the Government on cashless payments and its amendments (if any);

Pursuant to Circular No. .../.../TT-NHNN dated... month... year... of the State Bank of Vietnam on the provision of payment intermediary services and its amendments (if any);

Pursuant to the Resolution of the meeting of the Board of Members/Board of Directors/General Shareholders' Meeting, the document of the authorized representative of the owner of ...(1)... on the agreement to change the organization's name/headquarters address/suspend one or several licensed payment intermediary services/connect additional international payment systems of the organization providing international financial switch services as per License No. ... dated... month... year...;

Pursuant to the Certificate of Establishment/Business Registration Certificate/Certificate of Business Registration No. ... dated... month... year... issued for the ... time by ...;

Pursuant to other reasons (if any)

...(1)... requests the State Bank of Vietnam to amend and supplement the payment intermediary service operation license with the following specific details:

1. Name of the organization requesting the amendment and supplement of the payment intermediary service operation license:

• Full name in Vietnamese:

• Abbreviated name in Vietnamese (if any):

• Full name in English (if any):

• Abbreviated name in English (if any):

• Trading name (if any):

2. Business code/Tax code:

3. Address of the head office, phone number, fax number, email:

4. Payment intermediary service operation license No. ... dated... month... year... of the Governor of the State Bank of Vietnam.

5. Reason for requesting the amendment and supplement of the license (select the corresponding box):

□ Change of organization name

New name of the payment intermediary service provider after the change:

• Full name in Vietnamese:

• Abbreviated name in Vietnamese (if any):

• Full name in English (if any):

• Abbreviated name in English (if any):

• Trading name (if any):

□ Change of the head office address

New head office address:

□ Suspend one or several licensed payment intermediary services

• Name(s) of the payment intermediary services to be suspended:

• Expected time to suspend the provision of the payment intermediary services:

□ Connect additional international payment systems of the organization providing international financial switch services.

We commit to fully assume responsibility before the law for the legality, accuracy, and truthfulness of the contents of this Application. In the case of suspending one or several licensed payment intermediary services, we confirm that we have completed the resolution of tax obligations, debts, assets, and customer rights. If there is any violation, we accept full responsibility before the law.

Note: ...(1)... Name of the organization requesting the amendment and supplement of the payment intermediary service operation license.

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