Orange Konnecta Application Form

Type of Application *

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

Name *

Telephone

Company

Mobile phone

Postal address

Email address *

Physical address

Town/Country *

Payment method *

Direct debit

Cash

Other

If other, please specify

Service options

12 Months

24 Months

36 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

PDF, JPG, JPEG, DOC, DOCX, XLS, XLSX, TXT

Valid Work / Residence permits of Director / Signatory

PDF, JPG, JPEG, DOC, DOCX, XLS, XLSX, TXT

Recent 3 months' bank statement / Annual Report

PDF, JPG, JPEG, DOC, DOCX, XLS, XLSX, TXT

Current Payslip

jpg, jpeg, png, pdf, doc, docx, ppt

Utility Bill / Copy of Lease

PDF, JPG, JPEG, DOC, DOCX, XLS, XLSX, TXT

Schedule of directors (Only applies to Business)

jpg, jpeg, png, pdf, doc, docx, ppt, pptx

Certificate of incorporation (Only applies to Business)

jpg, jpeg, png, pdf, doc, docx, ppt, pptx

Resolution requesting opening of Orange account and stating payment responsibility & signatory (Only applies to Business)

jpg, jpeg, png, pdf, doc, docx, ppt, pptx

Customer details and Signatures

Name *

Designation *

Date *

Signature *

Check this box as an electronic signature

Orange Konnecta Application Form

Orange Konnecta Application Form

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