CUSTOMER REGISTRATION FORM

REGISTRATION IS FREE
Customer Details
Activated phone number: Customers full name: Date of birth: Physical Address: Estate / Village P.O Box Type of identication: National ID Military ID ID Number: Next of kin Name Relation Dealer Details Dealers code The Zap Customer Terms of Use are available at Zap Dealers and Airtel Centers countrywide and on the Airtel website www.airtel.com Zap I certify that all the above information is correct and I would like to register for the Zap Services provided by Airtel in accordance with the Zap Customer Terms of Use set out overleaf. I
conrm that I have read and understood the Zap Customer Terms of Use and I accept them. This Zap Customer Application Form and the Zap Customer Terms of Use constitute an ocially binding agreement between the two parties.

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DD/MM/YYYY

Gender:

Male Town

Female

Code: Alien ID Passport

Alternative No: Driving Licence Other ____________________________________________________

Contact No Signature

SIM I conrm to the best of my knowledge that the information provided above is true and I understand that I will be liable for misuse of my SIM card and number.
__________________________________________________________(the Individual Customer) and Signature_________________________ Date _ _ _ _ _ _ _ _ DD/MM/YYY