Orange Fiber Application Form

Orange Konnecta Fiber

Type of apllication *

Personal Account Holder *

Mr.

Mrs.

Ms.

Name *

Surname *

Date of birth *

ID/Passport number *

Telephone

Mobile phone

Next of kin

Relation

Email *

Contact number *

Occupation

Self employed *

Name of employer

Biling details for this contract

Email invoice

Mail invoice

Name *

Telephone

Company

Mobile phone

Postal address

Email address *

Physical address

Town/Country *

Payment method *

Direct debit

Cash

Cheque

Other

If other, please specify

24 Months

12 Months

Required documentation – attached to form. Please check and tick *

Schedule of director

Certificate of incorporation

Resolution requesting opening of Orange account and stating payment responsibility & signatory

Valid ID / (Passport for Non-Citizens) of Director / Signatory

Valid Work / Residence permits of Director / Signatory

Recent 3 months' bank statement / Annual Report

Utility Bill / Copy of Lease

Valid ID / (Passport for Non-Citizens) of Director / Signatory