PORTSONLINE REGISTRATION FORM - Transnet …

1 PORTSONLINE REGISTRATION form ONLINE User Details: (PLEASE USE BLOCK LETTERS) Title (Mr.; Mrs.,)* _____ First Name: * _____ Surname: * _____ Company:* _____ Physical Address: _____ _____ City: _____ Office telephone:* _____ Office facsimile: _____ Cellphone: _____ Email address: * _____ Role/s required: Cargo dues Submission Container Operator (Releases Only) Manifest Submission Outturn Report Submission Marine Services TNPA Account Number/s: Account Number Port Account Number Port 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Authorised representative of company Name: * _____ Designation: * _____ Telephone: _____ Email: * _____ Company Stamp Kindly Note: 1. The information supplied in this REGISTRATION form will be held by Transnet National Port Authority for the purposes of PORTSONLINE only and will only be amended or changed on written instructions from the authorized signatory hereof.

2 Transnet National Ports Authority further warrants that the information will be held in a secure database; 2. Transnet National Ports Authority reserves the right to make any final decisions regarding which individuals / Customers are registered onto the PORTSONLINE facility and can also terminate or refuse access to any user at anytime if user is not acting in accordance with the Electronic Data Interchange Agreement, eMail Legal notice linked to all emails send to registered user and the PORTSONLINE Terms and Conditions; 3. Transnet National Ports Authority can only accept completed REGISTRATION forms and it is your responsibility to maintain the above information; 4. I the undersigned, hereby grants Transnet National Ports Authority all rights to the information provided and warrant that the information provided are accurate and true. I understand that Transnet National Ports Authority endeavors to ensure the accuracy of the information contained on the database but accepts no responsibility for any errors or omission or liability or loss of data howsoever arising _____ User Authorised representative Who warrants his/her authority to sign Who warrants his/her authority to sign For Office Use Only User Id Date(dd/mm/yyyy) Created by Date User Notified Fields marked with * are mandatory