Main application form
New Cancellation Change of address
Required documents
Copy of Trade Licence Copy of establishment card Passport/Visa copy Letter of Authorisation
Customer information
Company name: Company Account number (if applicable):
Trade Licence number: Trade Licence expiry date: / /
DD MM YYYY
Establishment card number: Establishment card expiry date: / /
DD MM YYYY
Parent company (if applicable):
*CNAP name:
Mandatory for commercial establishments and private companies. Optional for government entities owned or affiliated with the U.A.E. Government,
embassies and consulates and diplomatic offices in U.A.E. only.
*Nature of business Banking or banking services Real estate services
Educational services Retail services
Gov. institutions services Tourism services
Health services Others:
Number of employees 10 or less 10-20 21-99 100 or more
Company address (physical address)
*Floor/office number: Building name/number: Plot number (if available):
*P.O. Box: Emirate: Country:
Nearest landmark: Old address (in case of address change):
Billing address
*Title *First name Middle name *Family name
Job title: Office/business telephone number:
Mobile number: Email address: Fax number:
P. O. Box: Emirate: Country:
Authorised signatory
*Title *First name Middle name *Family name
Job title: Office/business telephone number:
Mobile number: Email address: Fax number:
Technical contact
Main facilities or IT contact (responsible for telecommunication and IT services)
*Title *First name Middle name *Family name
Job title: Office/business telephone number:
Mobile number: Email address: Fax number:
We’re here to help. Call us on 800188
Payment method Cash Cheque Bank Transfer Credit Card
Billing information
Bill delivery: Email only Email and hard copy Email:
Language: English Arabic
Agreement
We’ll use the above information to contact you via email, phone or SMS. If you don’t wish to be contacted about our products or special promotions,
tick here .
I agree by signing below that I have the authority to sign on behalf of the named customer; that I’ve ordered the services indicated in this form and that
I accept the Terms and Conditions as stipulated in the subsequent pages of this application form. I take full responsibility for the use of all du services
provided to us.
*Customer signature: Stamp:
/ /
Date:
DD MM YYY
For official use only
Sales work order number: Customer ID number:
For retail
Sales Agent location: Sales agency code:
For indirect/direct sales
Account/Partner Manager name: Imran Siddique Account/Partner Manager ID:
Partner name: Aston Hill Partner/Dealer ID: Sales Executive name: Mirza Abdullah
Mobile number: 0582332773 Sales Support Agent name: Sumra
