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Carte Identification Nationale (CIN)
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ID Expiration Date
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Afghanistan
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France
Polynésie française
Gabon
La Gambie
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Allemagne
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Gibraltar
Grèce
Groenland
Grenade
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Guam
Guatemala
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Guinée
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Guyane
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Hong Kong
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Inde
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Iraq
Irlande
Israël
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Jamaïque
Japon
Jersey
Jordanie
Kazakhstan
Kenya
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Corée du Nord
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Kosovo
Koweït
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Laos
Lettonie
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Malawi
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Mali
Malte
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Île Maurice
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Chine
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Colombie
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Congo
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Costa Rica
Cote d'Ivoire
Croatie
Cuba
Curaçao
Chypre
République Tchèque
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Danemark
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Dominique
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Egypt
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Samoa
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Arabie saoudite
Sénégal
Serbie
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Singapour
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Îles Salomon
Somalie
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Transnistrie Pridnestrovié
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Turkménistan
Îles Turques-et-Caïques
Tuvalu
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Afghanistan
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Colombie
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Costa Rica
Cote d'Ivoire
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République Tchèque
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Danemark
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Pologne
Portugal
Porto Rico
Qatar
République du Congo
Roumanie
Russie
Rwanda
Saint-Barthélémy
Sainte Hélène
Saint-Christophe-et-Niévès
Sainte-Lucie
Saint-Marin
Saint-Pierre-et-Miquelon
Saint-Vincent-et-les-Grenadines
Samoa
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Arabie saoudite
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Employer Name
If Self Employed type '' SELF''
Employer Activity sector code
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00- Unemployed
72 - Accommodation and food services
72111 Hotels (except casino hotels) and motels
72112 Casino hotels
721191 Bed and breakfast
721192 Housekeeping cottages and cabins
721198 All other traveller accommodation
721211 Recreational vehicle (RV) parks and campgrounds
721212 Hunting and fishing camps
721213 Recreational (except hunting and fishing) and vacation camps
7213 Rooming and boarding houses
72231 Food service contractors
72232 Caterers
72233 Mobile food services
7224 Drinking places (alcoholic beverages)
7225 Full-service restaurants and limited-service eating places
56 - Administrative and support, waste management and remediation services
5611 Office administrative services
5612 Facilities support services
5613 Employment services
56141 Document preparation services
56142 Telephone call centres
56143 Business service centres
56144 Collection agencies
56145 Credit bureaus
56149 Other business support services
5615 Travel arrangement and reservation services
56161 Investigation, guard and armoured car services
561621 Security systems services (except locksmiths)
561622 Locksmiths
56171 Exterminating and pest control services
56172 Janitorial services
56173 Landscaping services
56174 Carpet and upholstery cleaning services
56179 Other services to buildings and dwellings
56191 Packaging and labelling services
56192 Convention and trade show organizers
56199 All other support services
5621 Waste collection
5622 Waste treatment and disposal
5629 Remediation and other waste management services
11 - Agriculture, forestry, fishing and hunting
111 Crop production
1111 Oilseed and grain farming
1112 Vegetable and melon farmig
1113 Fruit and tree nut farming
1114 Greenhouse, nursery and floriculture production
1115 Other crop farming
112 Animal production and aquaculture
1121 Cattle ranching and farming
1122 Hog and pig farming
1123 Poultry and egg production
1124 Sheep and goat farming
1125 Aquaculture
1129 Other animal production
113 Forestry and logging
114 Fishing, hunting and trapping
1151 Support activities for crop production
1152 Support activities for animal production
1153 Support activities for forestry
71 - Arts, entertainment and recreation
71111 Theatre companies and dinner theatres
71112 Dance companies
71113 Musical groups and artists
711211 Sports teams and clubs
7113 Promoters (presenters) of performing arts, sports and similar events
7114 Agents and managers for artists, athletes, entertainers and other public figures
7115 Independent artists, writers and performers
71211 Museums
71212 Historic and heritage sites
71213 Zoos and botanical gardens
71219 Nature parks and other similar institutions
7131 Amusement parks and arcades
7132 Gambling industries
71391 Golf courses and country clubs
71392 Skiing facilities
71393 Marinas
71394 Fitness and recreational sports centres
71395 Bowling centres
71399 All other amusement and recreation industries
23 - Construction
2361 Residential building construction
2362 Non-residential building construction
2371 Utility system construction
2372 Land subdivision
2373 Highway, street and bridge construction
2379 Other heavy and civil engineering construction
23811 Poured concrete foundation and structure contractors
23812 Structural steel and precast concrete contractors
23813 Framing contractors
23814 Masonry contractors
23815 Glass and glazing contractors
23816 Roofing contractors
23817 Siding contractors
23819 Other foundation, structure and building exterior contractors
23821 Electrical contractors and other wiring installation contractors
23822 Plumbing, heating and air-conditioning contractors
23829 Other building equipment contractors
23831 Drywall and insulation contractors
23832 Painting and wall covering contractors
23833 Flooring contractors
23834 Tile and terrazzo contractors
23835 Finish carpentry contractors
23839 Other building finishing contractors
2389 Other specialty trade contractors
61 - Educational services
6111 Elementary and secondary schools
6112 Community colleges and C.E.G.E.P.s
6113 Universities
61141 Business and secretarial schools
61142 Computer training
61143 Professional and management development training
6115 Technical and trade schools
61161 Fine arts schools
61162 Athletic instruction
61163 Language schools
61169 All other schools and instruction
6117 Educational support services
52 - Finance and Insurance
52211 Banking
52213 Local credit unions
52219 Other depository credit intermediation
5222 Non-depository credit intermediation
52231 Mortgage and non-mortgage loan brokers
52232 Financial transactions processing, reserve and clearing house activities
52239 Other activities related to credit intermediation
523 Securities, commodity contracts, and other financial investment and related activities
5241 Insurance carriers
52421 Insurance agencies and brokerages
524291 Claims adjusters
524299 All other insurance related activities
5261 Pension funds
5269 Other funds and financial vehicles
62 - Health care and social assistance
6211 Offices of physicians
6212 Offices of dentists
62131 Offices of chiropractors
62132 Offices of optometrists
62133 Offices of mental health practitioners (except physicians)
62134 Offices of physical, occupational, and speech therapists and audiologists
62139 Offices of all other health practitioners
62141 Family planning centres
62142 Out-patient mental health and substance abuse centres
621494 Community health centres
621499 All other out-patient care centres
6215 Medical and diagnostic laboratories
6216 Home health care services
62191 Ambulance services
62199 All other ambulatory health care services
622 Hospitals
6231 Nursing care facilities
62321 Residential developmental handicap facilities
62322 Residential mental health and substance abuse facilities
6233 Community care facilities for the elderly
6239 Other residential care facilities
6241 Individual and family services
6242 Community food and housing, and emergency and other relief services
6243 Vocational rehabilitation services
6244 Child day-care services
51 - Information and cultural industries
511 Publishing industries (except internet)
512 Motion picture and sound recording industries
515 Broadcasting (except internet)
517 Telecommunications
518 Data processing, hosting and related services
51911 News syndicates
51912 Libraries and archives
51913 Internet publishing and broadcasting, and web search portals
51919 All other information services
55 - Management of companies and enterprises
551113 Holding companies
551114 Head offices
31-33 - Manufacturing
3111 Animal food manufacturing
3112 Grain and oilseed milling
3113 Sugar and confectionery product manufacturing
3114 Fruit and vegetable preserving and specialty food manufacturing
3115 Dairy product manufacturing
3116 Meat product manufacturing
3117 Seafood product preparation and packaging
3118 Bakeries and tortilla manufacturing
3119 Other food manufacturing
31211 Soft drink and ice manufacturing
31212 Breweries
31213 Wineries
31214 Distilleries
3122 Tobacco manufacturing
313 Textile mills
314 Textile product mills
315 Clothing manufacturing
316 Leather and allied product manufacturing
321 Wood product manufacturing
322 Paper manufacturing
323 Printing and related support activities
324 Petroleum and coal product manufacturing
3251 Basic chemical manufacturing
3252 Resin, synthetic rubber, and artificial and synthetic fibres and filaments manufacturing
3253 Pesticide, fertilizer and other agricultural chemical manufacturing
3254 Pharmaceutical and medicine manufacturing
3255 Paint, coating and adhesive manufacturing
3256 Soap, cleaning compound and toilet preparation manufacturing
3259 Other chemical product manufacturing
326 Plastics and rubber products manufacturing
3271 Clay product and refractory manufacturing
3272 Glass and glass product manufacturing
3273 Cement and concrete product manufacturing
3274 Lime and gypsum product manufacturing
3279 Other non-metallic mineral product manufacturing
331 Primary metal manufacturing
3321 Forging and stamping
3322 Cutlery and hand tool manufacturing
3323 Architectural and structural metals manufacturing
3324 Boiler, tank and shipping container manufacturing
3325 Hardware manufacturing
3326 Spring and wire product manufacturing
3327 Machine shops, turned product, and screw, nut and bolt manufacturing
3328 Coating, engraving, cold and heat treating and allied activities
3329 Other fabricated metal product manufacturing
3331 Agricultural, construction and mining machinery manufacturing
3332 Industrial machinery manufacturing
3333 Commercial and service industry machinery manufacturing
3334 Ventilation, heating, air-conditioning and commercial refrigeration equipment manufacturing
3335 Metalworking machinery manufacturing
3336 Engine, turbine and power transmission equipment manufacturing
3339 Other general-purpose machinery manufacturing
334 Computer and electronic product manufacturing
335 Electrical equipment, appliance and component manufacturing
336 Transportation equipment manufacturing
337 Furniture and related product manufacturing
3391 Medical equipment and supplies manufacturing
33991 Jewellery and silverware manufacturing
33992 Sporting and athletic goods manufacturing
33993 Doll, toy and game manufacturing
33994 Office supplies (except paper) manufacturing
33995 Sign manufacturing
33999 All other miscellaneous manufacturing
21 - Mining, quarrying, and oil and gas extraction
211 Oil and gas extraction
212 Mining and quarrying (except oil and gas)
213 Support activities for mining, and oil and gas extraction
81 - Other services (except public administration)
81111 Automotive mechanical and electrical repair and maintenance
81112 Automotive body, paint, interior and glass repair
811192 Car washes
8112 Electronic and precision equipment repair and maintenance
8113 Commercial and industrial machinery and equipment (except automotive and electronic) repair and maintenance
81141 Home and garden equipment and appliance repair and maintenance
81142 Reupholstery and furniture repair
81143 Footwear and leather goods repair
81149 Other personal and household goods repair and maintenance
81211 Hair care and esthetic services
8122 Funeral services
8123 Dry cleaning and laundry services
81291 Pet care (except veterinary) services
81292 Photo finishing services
81293 Parking lots and garages
81299 All other personal services
8131 Religious organizations
8132 Grant-making and giving services
8133 Social advocacy organizations
8134 Civic and social organizations
81391 Business associations
81392 Professional organizations
81393 Labour organizations
81394 Political organizations
81399 Other membership organizations
814 Private households
54 - Professional, scientific and technical services
54111 Offices of lawyers
54112 Offices of notaries
54119 Other legal services
541212 Offices of accountants
541213 Tax preparation services
541215 Bookkeeping, payroll and related services
54131 Architectural services
54132 Landscape architectural services
54133 Engineering services
54134 Drafting services
54135 Building inspection services
54136 Geophysical surveying and mapping services
54137 Surveying and mapping (except geophysical) services
54138 Testing laboratories
54141 Interior design services
54142 Industrial design services
54143 Graphic design services
5415 Computer systems design and related services
541611 Administrative management and general management consulting services
541612 Human resources consulting services
541519 Other management consulting services
54162 Environmental consulting services
5417 Scientific research and development services
5418 Advertising, public relations, and related services
54191 Marketing research and public opinion polling
54192 Photographic services
54193 Translation and interpretation services
54194 Veterinary services
54199 All other professional, scientific and technical services
91 - Public administration
911 National government public administration
912 Provincial and territorial public administration
913 Local, municipal and regional public administration
914 Aboriginal public administration
919 International and other extra-territorial public administration
53 - Real estate and rental and leasing
53111 Lessors of residential buildings and dwellings
53112 Lessors of non-residential buildings (except mini-warehouses)
53113 Self-storage mini-warehouses
531211 Real estate agents
531212 Offices of real estate brokers
53131 Real estate property managers
53132 Offices of real estate appraisers
53139 Other activities related to real estate
5321 Automotive equipment rental and leasing
53221 Consumer electronics and appliance rental
53222 Formal wear and costume rental
53223 Video tape and disc rental
5323 General rental centres
53241 Construction, transportation, mining, and forestry machinery and equipment rental and leasing
53242 Office machinery and equipment rental and leasing
533 Lessors of non-financial intangible assets (except copyrighted works)
44-45 - Retail trade
441 Motor vehicle and parts dealers
442 Furniture and home furnishings stores
443 Electronics and appliance stores
444 Building material and garden equipment and supplies dealers
4451 Grocery stores
4452 Specialty food stores
4453 Beer, wine and liquor stores
446 Health and personal care stores
447 Gasoline stations
448 Clothing and clothing accessories stores
45111 Sporting goods stores
45112 Hobby, toy and game stores
45113 Sewing, needlework and piece goods stores
45114 Musical instrument and supplies stores
4513 Book stores and news dealers
452 General merchandise stores
4531 Florists
4532 Office supplies, stationery and gift stores
4533 Used merchandise stores
45391 Pet and pet supplies stores
45392 Art dealers
45393 Mobile home dealers
45399 All other miscellaneous store retailers
4541 Electronic shopping and mail-order houses
4542 Vending machine operators
4543 Direct selling establishments
48-49 - Transportation and warehousing
481 Air transportation
482 Rail transportation
483 Water transportation
484 Truck transportation
485 Transit and ground passenger transportation
486 Pipeline transportation
487 Scenic and sightseeing transportation
488 Support activities for transportation
491 Postal service
492 Couriers and messengers
493 Warehousing and storage
22 - Utilities
2211 Electric power generation, transmission and distribution
2212 Natural gas distribution
22131 Water supply and irrigation systems
22132 Sewage treatment facilities
22133 Steam and air-conditioning supply
41 - Wholesale trade
411 Farm product merchant wholesalers
412 Petroleum and petroleum products merchant wholesalers
4131 Food merchant wholesalers
4132 Beverage merchant wholesalers
4133 Cigarette and tobacco product merchant wholesalers
414 Personal and household goods merchant wholesalers
415 Motor vehicle and motor vehicle parts and accessories merchant wholesalers
416 Building material and supplies merchant wholesalers
4171 Farm, lawn and garden machinery and equipment merchant wholesalers
4172 Construction, forestry, mining, and industrial machinery, equipment and supplies merchant wholesalers
4173 Computer and communications equipment and supplies merchant wholesalers
4179 Other machinery, equipment and supplies merchant wholesalers
4181 Recyclable material merchant wholesalers
4182 Paper, paper product and disposable plastic product merchant wholesalers
4183 Agricultural supplies merchant wholesalers
4184 Chemical (except agricultural) and allied product merchant wholesalers
4189 Other miscellaneous merchant wholesalers
41911 Business-to-business electronic markets
41912 Wholesale trade agents and brokers
Job Title
Monthly Salary Range
Veuillez sélectionner
Min. Salary - 15,000 HTG
15,001 - 25,000 HTG
25,001 - 50,000 HTG
50,001 - 100,000 HTG
100,001 - 200,000 HTG
200,001 - 350,000 HTG
more than 350,000 HTG
Tax address
Tax Street Address
Tax Street Address Line 2
Tax City
Tax State / Province
Tax Postal / Zip Code
Veuillez sélectionner
Afghanistan
Albanie
Algérie
Samoa américaines
Andorre
Angola
Anguilla
Antigua-et-Barbuda
Argentine
Arménie
Aruba
Australie
Autriche
Azerbaijan
Les Bahamas
Bahreïn
Bengladesh
Barbade
Biélorussie
Belgique
Belize
Bénin
Bermudes
Bhoutan
Bolivie
Bosnie-Herzégovine
Botswana
Brésil
Brunéi
Bulgarie
Burkina Faso
Burundi
Cambodge
Cameroun
Canada
Cap-Vert
Îles Caïmans
République Centre-Africaine
Tchad
Chili
Chine
Ile de Noël
Iles Coco (Quille)
Colombie
Comores
Congo
Îles Cook
Costa Rica
Cote d'Ivoire
Croatie
Cuba
Curaçao
Chypre
République Tchèque
République Démocratique du Congo
Danemark
Djibouti
Dominique
République dominicaine
Équateur
Egypt
El Salvador
Guinée Equatoriale
Érythrée
Estonie
Éthiopie
Îles Falkland
Îles Féroé
Fidji
Finlande
France
Polynésie française
Gabon
La Gambie
Géorgie
Allemagne
Ghana
Gibraltar
Grèce
Groenland
Grenade
Guadeloupe
Guam
Guatemala
Guernesey
Guinée
Guinée Bissau
Guyane
Haiti
Honduras
Hong Kong
Hongrie
Islande
Inde
Indonésie
Iran
Iraq
Irlande
Israël
Italie
Jamaïque
Japon
Jersey
Jordanie
Kazakhstan
Kenya
Kiribati
Corée du Nord
Corée du Sud
Kosovo
Koweït
Kirghizistan
Laos
Lettonie
Liban
Lesotho
Libéria
Libye
Liechtenstein
Lituanie
Luxembourg
Macao
Macédonie
Madagascar
Malawi
Malaisie
Maldives
Mali
Malte
Îles Marshall
Martinique
Mauritanie
Île Maurice
Mayotte
Mexique
Micronésie
Moldavie
Monaco
Mongolie
Monténégro
Montserrat
Maroc
Mozambique
Myanmar
Nagorny-Karabakh
Namibie
Nauru
Népal
Pays-Bas
Antilles néerlandaises
Nouvelle-Calédonie
Nouvelle-Zélande
Nicaragua
Niger
Nigeria
Nioué
Île Norfolk
République turque de Chypre du Nord
Northern Mariana
Norvège
Oman
Pakistan
Palaos
Palestine
Panama
Papouasie-Nouvelle-Guinée
Paraguay
Pérou
Philippines
Îles Pitcairn
Pologne
Portugal
Porto Rico
Qatar
République du Congo
Roumanie
Russie
Rwanda
Saint-Barthélémy
Sainte Hélène
Saint-Christophe-et-Niévès
Sainte-Lucie
Saint-Marin
Saint-Pierre-et-Miquelon
Saint-Vincent-et-les-Grenadines
Samoa
Saint Marin
Sao Tomé et Principe
Arabie saoudite
Sénégal
Serbie
Seychelles
Sierra Leone
Singapour
Slovaquie
Slovénie
Îles Salomon
Somalie
Somalie
Afrique du Sud
Sud Ossétie
South Sudan
Espagne
Sri Lanka
Soudan
Suriname
Svalbard
eSwatini
Suède
Suisse
Syrie
Taïwan
Tajikistan
Tanzanie
Thaïlande
Timor-Leste
Togo
Tokelau
Tonga
Transnistrie Pridnestrovié
Trinité et Tobago
Tristan da Cunha
Tunisie
Turquie
Turkménistan
Îles Turques-et-Caïques
Tuvalu
Ouganda
Ukraine
Émirats Arabes Unis
Royaume-Uni
Etats-Unis
Uruguay
Ouzbekistan
Vanuatu
Ville du Vatican
Venezuela
Vietnam
Iles Vierges Britanniques
Île de Man
Iles Vierges Américaines
Wallis et Futuna
Sahara Occidental
Yémen
Zambie
Zimbabwe
Autre
Tax Country
Tax disctrict
Tax region
Comments
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Banking Information..
Bank name
Veuillez sélectionner
BANQUE - Banque Nationale de Crédit - (BNC)
BANQUE - Unibank - (UNB)
BANQUE - Sogebank - (SOG)
BANQUE - Capital Bank - (CAB)
BANQUE - Banque de l’Union Haitienne - (BUH)
BANQUE - Banque Populaire Haitienne - (BPH)
BANQUE - Banque de la République d’Haiti - (BRH)
BANQUE - CitiBank - (CIT)
BANQUE - SOGEBEL - (SBL)
COOPERATIVE - Caisse d'Épargne et de Crédit membre Fédération le LEVIER - (CEC)
COOPERATIVE - Caisse Populaire membre de ANACAPH - (ANC)
COOPERATIVE - Institution de Financement Populaire membre de KNFP - (KNF)
COOPERATIVE - Mutuelle de Solidarité - (MSO)
SOCIÉTÉ FINANCIERE - SOFIDAI - (SFD)
SOCIÉTÉ FINANCIERE - SOFIHDES - (SFI)
SOCIÉTÉ FINANCIERE - ProFIN - (PFN)
SOCIÉTÉ FINANCIERE - SOFIN Ayiti Leasing - (AYL)
SOCIÉTÉ FINANCIERE - SOGEFAC - (SGF)
TRANSFERT - Western Union SOGEXPRESS - (SGX)
TRANSFERT - Western Union CAPITAL TRANSFERT - (CPT)
TRANSFERT - UNITRANSFER - (UNI)
TRANSFERT - C.A.M. Transfer - (CAM)
TRANSFERT - MONEYGRAM UNIBANK - (MNU)
TRANSFERT - MONEYGRAM BUH - (MNB)
TRANSFERT - MONEYGRAM CWT RAPID TRANSFÈ - (MNR)
ASSURANCES - Alternative Insurance Company - (AIC)
ASSURANCES - Uni Assurance S.A. - (UNA)
ASSURANCES - Soge Assurance S.A. - (SGA)
ASSURANCES - InterNationale Assurances S.A. - (INA)
ASSURANCES - Nationale d'Assurances S.A. - (NAS)
ASSURANCES - Multi Assurances SA - (MVS)
ASSURANCES - Haiti Sécurité Assurance S.A.- (HSA)
ASSURANCES - Compagnie d'Assurances d'Haiti S.A. - (CAH)
ASSURANCES - Office d’Assurance Accidents du Travail Maladie et Maternité - (OFM)
ASSURANCES - Office National d’Assurance Vieillesse - (ONA)
ASSURANCES - Office d’Assurance Véhicules Contre Tiers - (OAV)
MICRO FINANCE - Fonkoze S.A. - (SFF)
MICRO FINANCE - Finca Haiti S.A. - (FNC)
MICRO FINANCE - ACME S.A.- (ACM)
MICRO FINANCE - PALMIS - (PLM)
MICRO FINANCE - SOGESOL - (SGS)
MICRO FINANCE - Micro Crédit National - (MCN)
MICRO FINANCE - Micro Crédit Capital - (MCC)
CARTE - Visa UniCarte - (VUC)
CARTE - Visa Capital Carte - (VCC)
CARTE - MasterCard BUH - (VBU)
CARTE - Master Card SogeCarte - (MSG)
CARTE - MasterCard BUH - (MBU)
FINTECH - HaitiPay - LAJANCASH (LJC)
FINTECH - Digicel- MONCASH (MCS)
FINTECH - Natcom - NATCASH (NTC)
FINTECH - Tout Kote - Unibank (UTK)
FINTECH - SOGEIZI - Sogebank (SGI)
HTGCurrent account #
USDCurrent account #
Debit Card Number
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Client BillPay Information
Electricity meter
Water meter
Telecommunication
Education
Television
Need for Online Access
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no
Comments field
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Applicables Terms and Conditions
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I confirm and declare that I have read and that I accept the terms and conditions of HaitiPay S.A. mobile wallet service which are accessible online at https://haitipay.com/termsandconditions or at any HaitiPay agent locations. I certify that the information provided in my mobile wallet account application above is sincere and correct. HaitiPay S.A. will not be held, under any circumstances, responsible for information provided which would subsequently be revealed to be false. I declare that I am responsible for any manipulation carried out on my mobile wallet account using my secret personal identification number (PIN) of which I am the sole holder and responsible to keep secret and confidential from other people. I also agree to abide by the current user agreement for the product relating to the rights and personal safety measures to be adopted. I accept the fact that HaitiPay S.A. will not carry out an initiated transaction if the latter seems suspicious or if the account balance or account status does not allow it at the time it is initiated. I acknowledge that all fiduciary I certify that I have read and understood the product use agreement in force at the time of my membership and I undertake to respect any amendment to said agreement once communicated and published by HaitiPay SA through an accessible means such as, for example, the website: www.haitipay.com.
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