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EQUITY
i REQUEST FOR BUINESS NUMBER
ORGANISATION DETAILS
| [ORGANISATION NAME
TYPE OF BUSINESS
ZATEPHONE NUWBER (or SMS notification)
» |_| POSTAL ADDRESS AND PHYSICAL ADDRESS
| [EMAIC ADDRESS
BUSINESS NUMBER DETAILS
'3 PRFERRED BUSINESS NUMBERS T z 3.
\ZERUTY COLLECTION RECOUNT RANE AND NOWET
Validation of Data required (tick appropriately) Yes No
Do you vant Biter Maintenanceas pes shor code yer C] ny
Do you ned integration with your systems Yes w O
If yes fill in below Connection information,
i i CONNECTION ENVIRONMENT
TEST ENVIRONMENTE ¢(u/vaut p+porvndpoi) | PRODUCTTONENVIRONVENT Ey Gi iiau py pRURVSTAT
ENDPOINT URL ENDPOINT URL
ever arising from wrong data su
Completed by Applicant:
Contact IT Technical Person: Name, .Phone Number.
Account Signatories:
Name...
Signature,
Name... Signature,
Name...
Signature...
Date...
For Official Use Only
Name Date ‘Signature & Stamp
Officer Supervisor Manager
‘BGDM/Operations Manager
IO ADMINSTATOR
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