Fello QRIS Registration

Full Name

Date of Birth

City / Regency

Citizenship

Phone/Mobile

Place of Birth

Address

Province

Id Type

KTP

KITAS

Identity Number

Attach a photo of your ID

Click to choose a file or drag here
Accepts image files
Size limit: 10 MB

Data Merchant

Merchant Name

Operating hours

Bank account information for disbursement

Upload business/product images

Click to choose a file or drag here
Accepts image files
Size limit: 10 MB

Merchant Address

Is the same as the owner's address

Full Merchant Address

City / Regency Merchant

Province Merchant

Monthly income

NPWP

Business Sector

Signature

Tanda Tangan Digital