WHOLESALER SIM PROCESSING REQUEST

Tel No: +27 010 010 0777 | Email: sales@voiceanddata.co.za

Reg No: 2008/008045/07
Address: 134 Walton Rd, Carlswald, Midrand, Gauteng, 1684.
Postal: P.O Box 467, Halfway House. 1685

Date: DD/MM/YYYY Account No:

Subscriber Details
Individual/Company Name:

Trading as: (if applicable)

ID/Company Reg No: Tel Account No:

Physical Address:
Street Code:

Email Address: Contact Tel No: ( )

Request for New Sim(s)

Inventory Quantity
MTN Vodacom Telkom Required
Min (Sims Left) Max (Allowed)

15

15

15

Existing Sims on Inventory

MTN Vodacom Telkom Telephone Number ICCID

Sim Cancellation Request

MTN Vodacom Telkom Telephone Number ICCID

Subscriber Declaration

Acknowledgement of RICA Requirements

Signed at on this DD/MM/YYYY

Authorised
Witness:
Signatory:

OCTOBER / 2019