Application Form

Deal Description:

Contract Value:

Contract Term:

Contract Type

Current Network Provider

Cell Number:

Title:

Initials:

Gender

Marital Status:

First Names:

Last Name:

ID / Passport:

ID Type:

Passport Expiry:

Passport Country of Issue:

Home Telephone:

Postal Address:

City

Province

Code

Country

Email:

Cell Number:

Next of Kin First Name:

Last Name:

Relationship:

Contact Number:

Business Type: Business Type:

Reg. No.:

Company Name:

VAT No.:

Nature of Business:

Trading as:

Email:

Telephone Number:

Postal Address:

City

State/Province

Zip/Postal

Country

Trading for (Years & Months):

Holding Company Name:

Director ID:

Director/Administrator Name:

Permission to Market:

Yes

Marketing Method:

Permission to Credit Check:

Yes

Unit Number:

Building Name:

Street Number:

Street Name:

Town/City:

Code:

Province:

Residence Type:

Period at Current Residence:

Company Name:

Company Telephone:

Contact Person:

Employer Industry:

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:

Bank:

Branch:

Branch Code:

Title:

Initials:

First Names:

Last Name:

Relationship:

ID Type:

Gender:

ID / Passport Number:

Home Telephone:

Physical Address:

City

State/Province

Zip/Postal

Country

Employer Name:

Gross Monthly Income:

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

, 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.

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.

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.

Alfa Mobile bills 1 month in arrears and the new allocation will activate on the 6th of every month.

A Pro Rata amount will be charged from date of activation till the 5th.

To cancel a contract prior to reaching term date, the full balance of contract will become due and payable.

Signed On

Authorised Signatory Name:

Signature

Clear

Supporting Documents:

Copy of ID or Director's ID in the case of a Company

Maximum file size: 516MB

Proof of Address

Maximum file size: 516MB

Last 3 Months Bank Statements

Maximum file size: 516MB

Company Document (If Applicable)

Maximum file size: 516MB

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Application Form

Application Form

Supporting Documents: