Electronic and Postal Communication (Licensing)
G.N. No. 430 (contd)
(ii) Street Name
(iii) Postal Address (P. O. Box.), if any
(iv) District or Region
(v) Post code
(b) Other Contact Address
(i) Employer physical address
(ii) Telephone number(s)
(iii) Email Address(es)
(c) Occupation ……………………………
(5) Identification
(a) Identity Number(ID)
(b) ID Issued by
(c) Type of ID
(i) Passport
(ii) Work ID
(iii) Driver’s Licence
(iv) Voter’s ID
(v) Local Government Letter attached with a photograph
(vi) Others (mention)
B.
SIM card Information
(1) Customer Mobile Number
(2) SIM Serial Number
(3) IMEI/ESN
C.
Acknowledgement
(a) Acknowledgement Statement
I confirm to the best of my knowledge that the information provided above is
true and I understand that I will be liable for the misuse of my SIM card and
number
(b) Date (dd/mm/yyyy)
(c) Signature
D.
Registering Agent Information
(a) Attended by (Name)
(b) Vendor Code
(c) Company Name
(d) Date (dd/mm/yyyy)
(e) Signature
(f) Location
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