Application Form [PDF]

Zitiervorschau

Contact No :

Date :

Name of applicant Mr./Mrs./Ms P.O Box : 0

Emirate: Abu Dhabi

Na onality :

ID Type : UAE iden ty Card ID Document No :

Date of Issuance:

Date of Expirty :

Visa No :

Date of Issuance:

Date of Expirty :

Date of Birth :

Gander : Male

Working No :

I would like to receive SMS updates about Etisalat's promotion and offers :NO Email : Account Number : Request Type : 1.Service Information Service Information

Rental

Special roming service

Perpayment

12

0

2. Device Details SIC Code

Description

IMEI

S/N

3. Bill Information Bill cycle

Address Line 1

Address Line 2

PO Box

Email (Bill to be sent on)

PO Box (Bill to be sent on)

4. Additional Info PRICE : 5. Your authorization

Terms and conditions Agreed

Customer Signature

Company Retail

Employee signature

For official only New Account No: Request No:

Code Sub Request :

Store Code Party ID :

Sales Staff : Igreham Authorized mangement

UNITED ARAB EMIRATES ETISALAT Etisalat Building, Sheikh Rashid Bin Saeed Al Maktoum Street P.O. Box 3838, Abu Dhabi, UAE Tel: 97126283333, Fax: 97126317000 www.etisalat.ae