Airtel
www.ng.airtel.com
Mobile Number Portability Form - Personal
PLEASE COMPLETE IN BLOCK LETTERS
Surname ………………………………………………………………………………… Other Names…………………….……………………………………….………..............
Address………………………………………………………………….…………………….……Street………………….……………………………………………….…………………
LGA………………………………………………….State…………………..…………………… Email (where applicable) ……………..……………………………………….
Gender………………………………………..… Date of Birth……………..……………………….………State of Origin……………………..………………………….…...
Mother’s maiden name …………………………………Customer Alternate number………………………………………………………………….…………………..
Type of Photo ID…………………………………………………………………….…..ID Number ……………………..………………………………………………………..…..
Mobile Current Airtel SIM Current Account New Time
Number Operator Serial Number Type Account Validation
to be Ported (Donor) Type SMS Sent
Pre-Paid Post-Paid Pre-Paid Post-Paid
1
2
3
* Donor: Subscriber Current Operator
Customer Declaration: I declare that the Information given is correct, that I am appointing AIRTEL to PORT my number, and that
Yes No
1 I am the current subscriber of the number(s) to be ported
I understand that all messages in the existing voice mailbox(es) and any undelivered SMS Yes No
2
and MMS messages may be lost
I understand that the new services available from AIRTEL will depend on the services available in the Yes No
3
package options I subscribe to with AIRTEL
Any configuration Information from my existing account(s) will not be transferred to Yes No
4
the new account
Yes No
5 I confirm that my existing SIM/number(s) has been registered with the donor operator
I understand that I will be responsible for recovering all outstanding mobile money account Yes No
6
balances with the donor operator
Yes No
7 I understand that any pre-paid credit with the donor operator will be lost
Yes No
8 I understand that I will have to pay any early termination charges due to the donor
I understand that I will have to pay the donor any subscription and call charges until Yes No
9
the account is closed
Customer Signature……………………………………………….or thumb print
Date:………………………………………………………………………..
For AIRTEL official use only
I confirm that I have checked the customer ID and retained a copy or captured the customer’s facial image: Yes No
Channel: Showroom Express shop Field Agent Channel Partner Others
Showroom or Express Shop Name……………………………….…………………………………………
Date – Validation SMS Sent…………………………………………….……………………………………..
Airtel Agent’s name………………………………………………………….……………………….. Signature……………………………………………………….