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Business Application Form - Al Buraq Telecoms

Business Application Form1. Office UseOrder No. Sales Agent ID/Salary Ref Dealer Code RICA Information (Required for Mobile Products)Customer Representative as RICA Agent RICA by Sales Agent RICA on Delivery 3. Directors/MembersName and Surname SA Citizen Yes No Identity/Passport No. Type of Permit/Visa Passport Exp. Date Name and Surname SA Citizen Yes No Identity/Passport No. Type of Permit/Visa Passport Exp. Date 2. Business Customer DetailsExisting or New telkom Customer Existing New Account No.

b) Telkom Mobile Subscriber Terms and Conditions (mobile services and products) available at telkommobile.co.za/terms/; and as indicated on any promotional material and/or on Telkom’s official product website (www.telkom.co.za) and/or communicated to me telephonically during a

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