JvH J. van Huuksloot Asset Management B.V.

—Enquiry

Submit your file for assessment.

Approximately thirty minutes. Where exact figures are not yet known, an approximate range is acceptable. We respond within five (5) business days with an initial fit assessment.

All correspondence is treated confidentially. Submitting this form does not create a contractual relationship — it is the first step in our assessment process. Required fields are marked with *.

AAbout the merchant

The applying entity.

Legal name of the merchant *

Country of incorporation

Registration number

Principal business activity

Merchant Category Code (MCC)

The MCC applied to your processing relationship with the counterparty.

Is the merchant a subsidiary of a publicly listed parent?

Yes No

If yes — parent name and listing venue

Contact name *

Role

Email *

Phone

BAbout the counterparty

The regulated PSP.

Legal name of the counterparty *

The regulated payment service provider.

Jurisdiction & supervisory authority

Authorisation type

Has the counterparty been acquired, restructured or rebranded during the relevant period?

If yes, a brief description; we will ask for documentation later if relevant.

Counterparty point of contact known to the merchant

CMerchant relationship

The underlying agreement.

Date of MSA execution

Governing law of the MSA

Jurisdiction clause

Approximate last processing date

Has the Merchant Services Agreement been terminated?

Yes No

If yes — date of termination and the party that initiated it

Stated reason for termination (if applicable)

DAggregate amount

The dispute.

Aggregate amount in dispute (best current estimate)

A range is acceptable. We re-confirm the quantum during reconciliation.

Heads of claim asserted (tick all that apply)

Withheld settlement balance Rolling reserve retained beyond release period Scheme passthrough recovery (Visa, Mastercard, other) VIRP fine or scheme assessment contested as unproven Chargeback programme assessment contested as unproven Internal adjustment unsupported by documentary evidence Refund liability or pass-through cost Other

Other — specify

Duration of merchant fund retention (months)

Documentary completeness

EDuration and conduct

Posture to date.

Date the dispute first arose (approximate)

Counterparty payment, partial release, or admission

Formal demand, letter before action, or regulatory complaint served

Currently in settlement or pre-action correspondence with the counterparty?

FAny other information

Strategic context.

Any factual matter, documentary record, strategic consideration, or potential complication we should be aware of

By submitting this form you confirm that you are authorised to share the information provided and that JvHAM may process it for the purpose of conducting an initial fit assessment. See our privacy notice.

We respond within five (5) business days.