Poa Communication Services Limited

Maelezo ya Wakala / Agent Information

Title:

First Name:

Last Name:

Business Name:

Nationality:

Mobile Number:

Date of Birth:

Gender:

Address:

Physical Address:

City:

District:

Country:

Email Address:

Utambulisho / Identification

ID Number:

Issued By:

Type of ID:

Nathibitisha maelezo niliyotoa hapo juu ni ukweli mtupu na nafahamu kwamba nitawajibika kwa matumizi mabaya ya simcard na namba yangu.

I confirm 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 simcard and number

Kwa matumizi ya ofisi tu / For official use only

Till Number:

Agent Number: