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Subscriber

This document is a subscription form for MultiChoice Africa Limited's DStv satellite television services. It contains the subscriber's personal details such as name, address, identity number, and contact information. It also lists the specific DStv package and products subscribed to, including any add-on services. Payment details such as method and amount are provided. By signing, the subscriber confirms the accuracy of the information and agrees to the terms and conditions of the subscription.

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Valentino Khoja
Copyright
© © All Rights Reserved
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189 views1 page

Subscriber

This document is a subscription form for MultiChoice Africa Limited's DStv satellite television services. It contains the subscriber's personal details such as name, address, identity number, and contact information. It also lists the specific DStv package and products subscribed to, including any add-on services. Payment details such as method and amount are provided. By signing, the subscriber confirms the accuracy of the information and agrees to the terms and conditions of the subscription.

Uploaded by

Valentino Khoja
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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SMART CARD

SERIAL No.
STB No.

Acc. No.

MultiChoice Africa Limited


Registration Number 43308 C1/GBL

SUBSCRIBER DETAILS

Mr./Mrs./Ms. Other Initials Fax No.

Surname E-Mail

First Names

Physical Address

Identity
No.
Passport City
No.
Tel. No.
Home Country

Tel. No.
Work Postal Address

Tel. No.
Mobile

AGENT DETAILS
Agents/Installer
Name: Agent Stamp

Tel. No.

Fax No.

Mobile No.

E-Mail

PAYMENT METHOD: PRODUCT DETAILS: RECEIPT DETAILS:


Direct Debit Cheque Cash Bank Draft
DStv
Services IS 7 IS 1O
Bank: Branch Code: RECEIPT No.
Branch Name: W4 / Sesat CURRENCY
Account No.:
Product
Type of Account: Savings Cheque Trans- AMOUNT PAID
mission PVR XtraView

VISA Master Other


Card Dual View

Card No. Subscription Period Months


Agent’s Signature

Expiry Date CVV


No.

SUBSCRIBER ACCEPTANCE
“The Subscriber:
Signed At:
confirms the accuracy of the above mentioned personal information,
acknowledges that he/she has read and understands the Terms and Conditions to this application,
RF56650(v)

upon acceptance of the application by MultiChoice Africa Limited, undertakes to be bound thereby, and Date:
confirms receipt of the smart card in good working order”.
Your Subscriber Application Form must be read together with the Multichoice Digital Satellite Terms and
Lithotech SJ (011) 474-1828

Conditions (Sub-Saharan Africa), and the current version of the User Manual applicable to your decoder, both
of which will be made available upon request and/or are accessible on MultiChoice’s website.
Would you like a copy of the terms and conditions? Yes No Subscriber's Signature:

For MultiChoice use only: Subscriber No. User ID: Date Captured:

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