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Registration Form

Please fill out the application form, ensuring a clear description of your product/service or idea is given.
With a project document or business plan file attached.


CUSTOMER INFORMATION
Kindly fill out the form below and click on the submit button. You will be required to confirm the provided information, after which you click on 'continue' for the information to be submitted.

The fields marked * are mandatory.
Title:
First Name: *
Last Name: *
E-mail Address: *
Alternative number(s)
Please provide an alternative phone number
on which you can be reached during the day.
*
INFORMATION ON OLD SIM (STOLEN/LOST/DAMAGED)
Was your Etisalat line: Stolen?
Lost?
Damaged?
Enter the phone number of the stolen/lost/damaged line *
CORE QUESTIONS : please fill carefully (proceed to SUPPLYMENTARY questions if you are able to answer only 2 of the questions)
PUK number on old SIM pack *
Serial number on old SIM pack *
What 3 GSM numbers do you frequently dial? please insert the full phone number e.g 0809000000 *
*
*
Service history
(3 services activated on the line)
*
*
*
The Year of SIM activation: *
SUPPLEMENTARY QUESTIONS : please fill carefully
Package type *
Your registered 'You' and 'Me' number (if any) *
Last 3 transactions
(eg voice, SMS, recharge)
*
*
*
Swap History
(The number of swaps done on the line)
*
Freebies available on the your package *
Package history *
Phone used before incidence (SIM swap, request for PUK no, etc.) *
Current balance *
How much credit did you load when you last recharged? *
INFORMATION ON NEW LINE TO BE USED FOR THE SWAP
Please provide the number of the new line that you bought for this SIM SWAP *
Please provide the serial number of the new line that you bought for this SIM SWAP.

Remember that the Prepaid line has to be new, which you have NOT yet inserted into a handset.

Phone number of the new line, starting with 0809, 0817, 0818 or 0909.
*