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Telkom Consumer Application Form - WPG

Consumer Application Form Agent to complete: New Application Contract renewal Change of ownership Porting of mobile number Customer relocation Service required Fixed Mobile Convergence Agent name Campaign name Order no. Account no. System customer ID. Supporting documentation Proof of identification (certified copy of SA ID or passport). Copy of your most recent payslip and 3 months' bank statements Copy of proof of residence (utility bill not older than 3 months). For porting purposes, account number at donor/existing service provider required ORIGINAL. 1. Customer details Are you an existing customer? Yes No If yes, what is your existing telephone number? Title Surname First Names SA Citizen Yes No Identity/Passport No.

Please debit my account in favour of Telkom SA SOC Ltd with my total amount due each month. Bank Branch Name Branch Code Account Holder Name Account No. Type of Account Cheque Transmission Savings Debit order maximum amount R Debit Dates 15th 25th Last day of …

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