MTN Dedicated Internet Access Agreement

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

Salesperson

Select 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*

Choose file

Company certificate*

Choose file

(Certificate of Incorporation or Valid trading license)

Company letter on letter head*

Choose file

Proof of address for Director*

Choose file

Proof of ID for Director*

Choose file

Customer Documents

Tax Clearance Certificate

Choose file

Trading License

Choose file

Resolution Letter

Choose file

Form J (listing of Directors)

Choose file

Government gazette

Choose file

3 Months Bank statements

Choose file

PIN/Passport

Choose file

Memorandum

Choose file

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