Contact Details Driver

Consumer Application Form

Dealer name

Are you an existing customer? If yes, what is your existing number? Have you checked your coverage?

Dealer LTE code

Y N

Company’s contact no.

ID no.

Y N

Y N

Title

Company name

Gross income p/m

Total expenses p/m

R Net income p/m

R

ORIGINAL Page 1

provided electronic authorisation on at for

SA SOC Ltd to debit his/her bank account.

provided electronic authorisation on at for

SA SOC Ltd to perform a credit check on his/her ID. Debit dates

R

Household income p/m R

SA citizen

Contact details Mobile no. Office no.

Alternate Mobile no.

Email address

Gender M F

Surname

Coverage address

Delivery address

Postal code

First names

Apply for LTE New application

How do you want to receive your invoice? Email (Compulsory for all broadband services) Cheque Transmission Savings

5th 15th 20th 25th

Type of account

1. Customer details

2. Employment details

Please debit my account in favour of Telkom SA SOC Ltd with my total amount due each month. Should any debit orders be returned unpaid on the due date, you will be liable for a debit order rejection fee. In addition,Telkom and/or its authorised debt collection agencies will also have the right to make use of NAEDO or Debicheck to collect the arrears amount, and you will also be liable for these collection costs. Bank

Account holder name Account no.

Branch name Branch code

3. Payment details (debit order compulsory)

Last day of the month

Credico

YDDDEF-0001

Mr Mawela Benjamin Moreleba

7 6 0 6 0 5 5 4 3 3 0 8 7

0 7 3 5 8 1 7 7 7 7 0 7 1 0 7 4 9 2 6 8

0 7 1 0 7 4 9 2 6 8

**************@*****.***

190, Thema Rd, Kwa Thema, Springs, 1563

190, Thema Rd, Kwa Thema, Springs, 1563

1 5 6 3

Self employed 0 7 1 0 7 4 9 2 6 8

19000.00 19000.00

2000.00 25000.00

Capitec Brakpan 4 7 0 0 1 0

B m mawela 142*******

Benjamin Moreleba Mawela

13 June 2020 21:15

Benjamin Moreleba Mawela

13 June 2020 21:13

Technology type

I, being the undersigned, declare, agree and confirm that: I am bound to the terms and conditions applicable to the transaction, including but not limited to: I declare myself familiar with and bound to the content of said terms and conditions. I hereby consent to credit-vetting this application.

All these terms and conditions are available online and will be emailed to me. has read, agreed and accepted the agreement and terms and conditions electronically on at . 1.

2.

3.

4.

1.

2.

3.

4.

If acting in a representative capacity, that I am duly and fully authorised to do so. I personally hereby indemnify and hold

harmless for any damages suffered by it, should it at any stage appear that I’m not so authorised. The information supplied herein with regard to me is complete, true and correct as at date of signature/electronic processing hereof.

Electronic processing of the transaction (telephonically or via Internet portal) will be binding on me, as if I have signed a physical application form, upon:

a) my agreement via tick box and submission of the online application form; or b) my verbal confirmation of the existence of the agreement during the telephonic application process. I shall be in breach of the Agreement by cancelling any debit order without the prior written consent of or where any debit order payment is returned unpaid or stopped. In such case, will have the right to suspend my account until such arrears amounts together with interest thereon at the interest rate have been received and paid in full. furthermore reserves the right to appoint external collection agencies that will be authorised to act on ’s behalf in the collection of any outstanding amounts. In addition, and/or its authorised collection agencies will also have the right to make use of NAEDO or Debicheck to collect the arrears amount, in which case I will be liable for all associated costs.

’s standard terms and conditions for the provision of electronic communication services and products (fixed-line services and products), available at www.telkom.co.za/sites/aboutus/regulatory/termsandconditions/.

’s mobile subscriber terms and conditions (mobile services and products), available at www.telkom.co.za/sites/aboutus/regulatory/termsandconditions/. Product-specific terms and conditions related to the service and/or product I have applied for, as indicated on any promotional material and/or on ’s official product website (www.telkom.co.za) and/or communicated to me telephonically during a telephonic application process. Spend limit refers to a maximum amount set to allow customers to purchase additional data bundles or stay connected by making OOB (Out Of Bundle) calls/usage in case they deplete their inclusive benefits during the month. Permanent spend limit for customers that renewed or signed new contracts with is automatically set at R1500 per month. However, customers can adjust their temporary and permanent spend limits by simply dialling *180# and choosing the Manage Spend Limit option on the USSD menu. Alternatively, it can be done through the portal by copying the following link into the browser: https://selfservice.telkom.co.za/rococo/public/content/interstitial. Note: Changes on he permanent spend limit are effective on the 1st of the following month, whereas changes on the temporary spend limit are effective immediately.

LTE

4. Your order/services required

5. Agreement

Deal ID Deal description

ORIGINAL Page 2

DSF1910200 Huawei B535 + R99 Once-Off Activation Fee On SmartBroadband 20GB Wireless @R269 x 24 Months (20GB ... Anytime Data + 20GB Night Surfer)

Benjamin Moreleba Mawela

13 June 2020 21:19

Contact this candidate