Device application form

Resources

Applicant details

Company name *

Place of incorporation *

Address of registered office *

Details of the authorised person

First name *

Last name *

Job title *

Phone number *

Email address *

Enter different contact details

Device functionality

Manufacturer *

Model *

Hardware Version *

Firmware Version *

Application Version

PCI Approval Number

PCI Security Standards Council's PTS Approval Number

Name and version of the PCI Security Standards Council's standard under which the device has been approved.

Is the device a PIN entry device (PED) or an unattended payment terminal (UPT)?

Supporting document

Attach the PCI Security Standards Council's letter of approval to your application

This should be a PDF, no more than 10MB in size

Applicant's agreement

The applicant acknowledges and agrees by submitting the Terminal registration application that the applicant requests Payments NZ to register a model of terminal.
The applicant acknowledges and agrees by submitting the Terminal registration application that if Payments NZ registers the model of terminal,-
1. Payments NZ does so on the basis of information provided by the applicant,
2. Payments NZ is entitled to rely on a letter from the PCI Security Standards Council and is not required to enquire or independently assess whether or not the model of terminal complies with a PCI Security Standards Council standard,
3. Payments NZ makes no representation or warranty that the model conforms with the PCI Security Standards Council standard specified by the applicant in this Terminal registration application as the standard under which the terminal has been approved,
4. Payments NZ makes no representation or warranty that Payments NZ will not at any time determine a date from which-
  1. it will stop registration of any model of terminal that conforms with the version of the PCI Security Standards Council standard specified by the applicant in this Terminal registration application,
  2. all terminals of the registered model may not connect for the first time to the switching network, or
  3. all terminals of the registered model must disconnect from the switching network,
5. if Payments NZ determines a date from which terminals of the registered model may not be connected for the first time to the switching network or must be disconnected from the switching network, Payments NZ-
  1. may make the determination for any reason, and
  2. makes no representation or warranty that the model of terminal does not conform with the PCI Security Standards Council standard specified by the applicant in this Terminal registration application, and
6. Payments NZ is not liable for any loss whether the loss is direct or consequential (including loss of profits), incurred by the applicant, any participant or any other person arising out of or in connection with Payments NZ-
  1. registering a model of terminal in accordance with the process set out in the Payments NZ rules,
  2. disclosing any confidential information of the applicant,
  3. exercising any of its rights or powers under the Payments NZ rules, or
  4. complying with any of its obligations under the Payments NZ rules.
7. Payments NZ is responsible for managing the process where the model of terminal registered by the applicant fails to protect sensitive data on a payment instrument from unauthorised disclosure or use in New Zealand or overseas and the applicant will-
  1. follow all instructions from Payments NZ given in accordance with the Payments NZ rules; and
  2. comply will the Compromised Terminal Disconnection Plan (such plan to be available on the Payments NZ website, as updated and amended from time to time).
The applicant warrants and represents by submitting the Terminal registration application that:
1. the model of terminal complies with the terminal registration requirements in the Payments NZ rules, and
2. the information in this Terminal registration application is correct and not misleading.
If the applicant becomes aware that any information in this Terminal registration application is incorrect or misleading, the applicant agrees to notify Payments NZ as soon as practicable after it becomes aware and to give Payments NZ details of the incorrect or misleading information. The applicant acknowledges that, if it has included any information in this Terminal registration applicationthat is incorrect or misleading, Payments NZ may remove the model of terminal from the register if it no longer complies with the terminal registration requirements set out in the Payments NZ rules.
The applicant agrees to provide Payments NZ with up to date and accurate contact details and will advise Payments NZ of any changes to its contact details. In the event that Payment NZ is unable to contact the applicant, after making reasonable attempts to do so, Payments NZ may remove the model of terminal from the register.
Payments NZ can amend the terms and conditions outlined in this Terminal registration application at any time by publishing amended terms and conditions on its public website and notifying the applicant, using the contact details provided by the applicant to Payments NZ, when the terms and conditions have been amended. The applicant acknowledges and agrees by submitting the Terminal registration application that the applicant will be bound by any amended terms and conditions from the date that they are published on Payments NZ's website.

Please tick this box to confirm that you, the authorised person named above, are duly authorised to submit this Device registration application for and on behalf of the applicant.

Yes, I am authorised *

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