Change Request Form
Please complete in block capitals in either blue or black ink.
Customer Details
Title: (Mr/Mrs/Miss/Ms) Full name:
In the event of a change of name - New Full name:
Date of birth: Day Month Year Mobile number:
Email:
Applies to Change of Address and/or Owner Change Only
Address:
Postcode
Contract Renewal / Tariff Change Only
Plan: Contract term chosen: Months
Handset supplied: Yes No Make: Model:
SIM Change
Old SIM:
New SIM:
Customer Declaration
I wish to: Change my account address Request that another person takes over my account
Renew my handset Change the subscription tariff associated with my phone number
Name change Cancel my phone number subscription - if so please give reason below:
The changes are to be effective from: Day Month Year
Is this number to appear in subsequent editions of the Jersey Telecom Directory? Yes No
I am the owner of the phone number specified above and wish Airtel-Vodafone to change the information associated with my account as specified in this form. I understand that Airtel-Vodafone’s
standard Terms & Conditions continue to apply to my account. I hereby accept that I will be responsible for any remaining charges associated with the phone number specified in this form.
I understand that the applicable Airtel-Vodafone Terms & Conditions are available on the Airtel-Vodafone website www.airtel-vodafone.com
Airtel-Vodafone may change the applicable Terms & Conditions from time to time and such Terms & Conditions will be published on the Airtel-Vodafone website.
Signed: Date: Day Month Year
The data collected in this form will be used to enable Airtel-Vodafone to process
Signed by second party where the account is to be in joint names: your order and will be kept on its systems as described in the Terms and Conditions.
The Company will only use this data to keep you updated with news about our
Signed: products and services.
If you do not wish to receive these updates, please tick here
Office Use Only
Printed name of sales staff representative: Dealer sales code:
Tick to confirm proof of address attached Tick to confirm directory entry verification
Tick to confirm copy of customers ID is attached Scanned to omnidocs: YES NO
Tick to confirm copy of credit check is attached Tick to confirm copy of marriage certificate is attached
Jersey Airtel Limited, 2nd Floor, Le Masurier House, La rue le Masurier, St Helier, Jersey JE2 4YE
Guernsey Airtel Limited, 45 High Street, St Peter Port, Guernsey GY1 2JT Ref: JAL/GAL CRF 1.0
