HTML Preview Renewal Business page number 1.
Sales consultant to complete:
Order no.
Account no.
Dealer code
Agent name
Agent ID/salary no.
RICA information Customer representative as RICA agent
RICA by sales agent
RICA on delivery
Supporting documentation
• Proof of identification: (certified copy of SA ID or passport)
+ permit of the passport of accountholder
3. Agreement
I, the undersigned, declare, agree and confirm that:
1. If acting in a representative capacity, that I am duly and fully authorised to do so. I personally hereby indemnify and hold Telkom harmless for any
damages suffered by it, should it at any stage appear that I’m not so authorised.
2. The information supplied herein with regard to me is complete, true and correct as at date of signature/electronic processing hereof.
3. 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 am bound to the terms and conditions applicable to the transaction, including but not limited to:
1. Telkom’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/; and/or
2. Telkom mobile subscriber terms and conditions (mobile services and products) available at
www.telkom.co.za/sites/aboutus/regulatory/termsandconditions/; and
3. 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
Telkom’s official product website (www.telkom.co.za) and/or communicated to me telephonically during a telephonic application process. I declare
myself familiar with and bound to the content of said terms and conditions. I hereby consent to Telkom credit-vetting this application.
Full name Signature Date
1. Business details
Business name
Company registration/Identity/Passport no. VAT no.
Cost centre
Contact person’s name and surname
Home no.
Office no.
Mobile no.
Fax no.
Email address
Telkom service number to be renewed
How do you want to receive your invoice? Email (compulsory for all broadband services) Post (additional charges may apply)
ORIGINAL V160714 Page 1
Business Contract Renewal/
Changes to Existing Services Form
2. Renewal/Changes required
A. Mobile and convergence solutions
Package/Deal ID
Device make/model
Itemised billing
Additional value-added services
Contract period
Yes No
Insurance Yes
No
Band Monthly premium
R
Telkom SA SOC Ltd is an authorised Financial Service Provider, FSP number: 46037, underwritten by Mutual & Federal Risk Finance Ltd, a member of the Old Mutual Group. I/We have purchased the Telkom Cellular
Insurance and hereby declare that it was done on a non-advice basis. Non-advice in respect of a purchase means that the Telkom Representative did not provide advice, did not make a recommendation,
nor provided guidance or made a proposal of a financial nature in respect of Telkom Cellular Insurance. Telkom Cellular Representative presented the benefits and features of Telkom Cellular Insurance which allowed
me to make an informed decision of my/our own.
B. Fixed-line and converged solutions
Fixed standalone
Calling plan (voice service)
Telkom Broadband service Yes No Contract period
Technology
Speed Fast
Faster Faster + Fastest Elite Elite + Delux 100*
Other
*Delux 100 is not availalble on DSL.
Internet plan
Self-install Yes
No
(installation charges applicable for month-to-month contracts)
Device add-on
VAS add-on
Virtual number
Converged bundles
Bundle description Technology Contract period