Document Comparison

Section 1: Assessment Information Instructions for Submission This document must be completed as a declaration of the results of the service provider’s self-assessment with the Payment Card Industry Data Security Standard Requirements and Security Assessment Procedures (PCI DSS). Complete all sections: The service provider is responsible for ensuring that each section is completed by the relevant parties, as applicable. Contact the requesting payment brand for reporting and submission procedures.

Part 1. Service Provider and Qualified Security Assessor Information Part 1a. Service Provider Organization Information Company Name: DBA (doing business as):

ISA Name(s) (if applicable): Title:

Lead QSA Contact Name: Title:

Name of service(s) assessed:

Type of service(s) assessed:

Applications / software Infrastructure / Network Physical space (co-location) Security services 3-D Secure Hosting Provider Shared Hosting Provider Other Hosting (specify):

Managed Services (specify):

Systems security services IT support Physical security Terminal Management System Other services (specify):

POS / card present Internet / e-commerce MOTO / Call Center Other processing (specify):

Account Management Fraud and Chargeback Payment Gateway/Switch Back-Office Services Issuer Processing Prepaid Services Billing Management Loyalty Programs Records Management Clearing and Settlement Merchant Services Tax/Government Payments Network Provider Others (specify):

Note: These categories are provided for assistance only, and are not intended to limit or predetermine an entity’s service description. If you feel these categories don’t apply to your service, complete “Others.” If you’re unsure whether a category could apply to your service, consult with the applicable payment brand.

Managed Services (specify):

Systems security services IT support Physical security Terminal Management System Other services (specify):

Account Management Fraud and Chargeback Payment …

Name of service(s) not assessed:

Type of service(s) not assessed:

Applications / software Hardware Infrastructure / Network Physical space (co-location) Storage Web Security services 3-D Secure Hosting Provider Shared Hosting Provider Other Hosting (specify):

POS / card present Internet / e-commerce MOTO / Call Center ATM Other processing (specify):

Provide a brief explanation why any checked services were not included in the assessment:

Part 2b. Description of Payment Card Business Describe how and in what capacity your business stores, processes, and/or transmits cardholder data.

Describe how and in what capacity your business is otherwise involved in or has the ability to impact the security of cardholder data.

Part 2c. Locations List types of facilities (for example, retail outlets, corporate offices, data centers, call centers, etc.) and a summary of locations included in the PCI DSS review.

Type of facility Number of facilities of this type Location(s) of facility (city, country) Example: Retail outlets 3 Boston, MA, USA

Payment Application Version Number Application Is application PA-DSS Listed? PA-DSS Listing Expiry date (if applicable) Part 2e. Description of Environment Provide a high-level description of the environment covered by this assessment.

For example:

• Connections into and out of the cardholder data environment (CDE).

• Critical system components within the CDE, such as POS devices, databases, web servers, etc., and any other necessary payment components, as applicable.

Does your business use network segmentation to affect the scope of your PCI DSS environment? (Refer to “Network Segmentation” section of PCI DSS for guidance on network segmentation) Part 2f. Third-Party Service Providers Does your company have a relationship with one or more third-party service providers (for example, gateways, payment processors, payment service providers (PSP), web-hosting companies, airline booking agents, loyalty program agents, etc.) for the purpose of the services being validated? Type of service provider: Description of services provided:

Note: Requirement 12.8 applies to all entities in …

 Full

• The requirement and all sub-requirements were assessed for that Requirement, and no sub- requirements were marked as “Not Tested” or “Not Applicable” in the SAQ.

 Partial

• One or more sub-requirements of that Requirement were marked as “Not Tested” or “Not Applicable” in the SAQ.

 None

• All sub-requirements of that Requirement were marked as “Not Tested” and/or “Not Applicable” in the SAQ.

For all requirements identified as either “Partial” or “None,” provide details in the “Justification for Approach” column, including:

 Details of specific sub-requirements that were marked as either “Not Tested” and/or “Not Applicable” in the SAQ  Reason why sub-requirement(s) were not tested or not applicable

Note: One table to be completed for each service covered by this AOC. Additional copies of this section are available on the PCI SSC website.

Name of Service Assessed:

PCI DSS Requirement Details of Requirements Assessed Full Partial None Justification for Approach (Required for all “Partial” …

Check with the applicable payment brand(s) before completing Part 4.