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Application Form
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Application Form
Application Form
Application Form
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Deal Description:
Contract Value:
Contract Term:
Contract Type
*
New Line
Port
Transfer
Current Network Provider
MTN
Vodacom
Cell C
Telkom Mobile
Other
Cell Number:
*
Title:
*
Initials:
*
Gender
*
Male
Female
Rather not say
Marital Status:
Single
Married
Divorced
Widowed
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First Names:
*
Last Name:
*
ID / Passport:
*
ID Type:
SA ID
Passport
Passport Expiry:
Passport Country of Issue:
Home Telephone:
Postal Address:
*
Email:
*
Cell Number:
*
Next of Kin First Name:
*
Last Name:
*
Relationship:
*
Contact Number:
*
Business Type:
Public Co.
PTY LTD
CC
Partnership
Sole Trader
Other
Business Type:
Reg. No.:
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Company Name:
VAT No.:
Nature of Business:
Trading as:
Email:
Telephone Number:
Postal Address:
Trading for (Years & Months):
Holding Company Name:
Director ID:
Director/Administrator Name:
Permission to Market:
*
Yes
No
Marketing Method:
*
Email
SMS
Tel.
Permission to Credit Check:
*
Yes
No
Unit Number:
Building Name:
Street Number:
*
Street Name:
*
Town/City:
*
Code:
*
Province:
*
Residence Type:
Owned
Rented
Other
Period at Current Residence:
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Company Name:
*
Company Telephone:
*
Contact Person:
Employer Industry:
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Job Title:
Period at Current Employer:
Gross Monthly Income:
Spouse Monthly Income:
Bank Account Type:
*
Current
Transmission
Savings
Age of Account:
*
Account Holder:
*
Account Number:
*
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Bank:
*
Branch:
*
Branch Code:
*
Title:
*
Initials:
*
First Names:
*
Last Name:
*
Relationship:
*
ID Type:
*
SA ID
Passport
Gender:
*
Male
Female
Rather not say
ID / Passport Number:
*
Home Telephone:
Physical Address:
*
Employer Name:
*
Gross Monthly Income:
*
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I have read, understood and agree to be bound by the terms and conditions below and declare that the information given above is true and correct and that I hereby consent to Alfa Mobile credit vetting this application
1.
*
, hereby confirm that all the below terms and conditions of the Alfa Mobile Application that is included in this proposal apply to this contract. All the terms and conditions are to be honoured by myself including payment.
2.
In the event of non-payment, I understand that I will be liable for the entire cost of the contract and any further charges incurred as a result of non-payment on my part.
3.
In the event of a default on my part relating to non-payment, I will be liable for a fee of R80, all bank charges, attorney’s costs, and any other costs incurred by Alfa Mobile in order to recover outstanding payments.
4.
Alfa Mobile bills 1 month in arrears and the new allocation will activate on the 6th of every month.
5.
A Pro Rata amount will be charged from date of activation till the 5th.
6.
7.
To cancel a contract prior to reaching term date, the full balance of contract will become due and payable.
Signed On
*
At
*
Authorised Signatory Name:
*
Signature
*
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Supporting Documents:
1.
2.
3.
4.
Copy of ID or Director's ID in the case of a Company
Proof of Address
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Last 3 Months Bank Statements
Company Document (If Applicable)
Submit
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