MTN Dedicated Internet Access Agreement

All fields marked with * are required, unless otherwise specified.

Salesperson

Name of salesperson

Subscriber details

Company Name *

Physical Address *

Postal Address *

Contact Number *

Category *

TIN Number *

Reg. Number *

Nature of Business *

Trading as *

Documentation

Please select a customer type. Documentation will be filtered according to the selected customer type selection *

Know Your Customer (VELA) Documents

Company Proof of address

Company certificate

(Certificate of Incorporation or Valid trading license)

Company letter on letter head

Proof of address for Director

Proof of ID for Director

Customer Documents

Tax Clearance Certificate

Trading License

Resolution Letter

Form J (listing of Directors)

Government gazette

3 Months Bank statements

PIN/Passport

Account Administrator / Authorised signatory

Account Administrator *

Name *

Email Address *

Telephone Number *

ID Number *

Authorised signatory * Same as administrator

Name *

Email Address *

Telephone Number *

ID Number *

Directors/Partners/Proprietors

Please list all directors

Director 1 *

Name *

Graded Tax Number *

Telephone *

ID Number *

Banking and Debit Order Details

Please add banking details *

Name of account holder

Account number

Branch code

Payment Options

Please select a payment option *

Cash Debit order MoMo

Debit Order Dates

Please select a payment option *

Pricing

Please select a package and see the corresponding information. You must include at least one package