Sim Card Registration Form

Fomu ya Usajili wa Mteja wa simu za mikononi Customer Registration Form TANZANIA TELECOMMUNICATIONS COMPANY LIMITED

Picha ndogo Passport Size photo

Namba ya msambazaji Vendors Code __________________________ Jina la Kampuni ya simu Name of Phone Company ___________________________________

MAELEZO YA MTEJA/ CUSTOMER INFORMATION Jina kamili Full Name : Tarehe ya kuzaliwa Date of Birth :…./…./…..

Gender:

Jinsia: Mwanaume Male

Mwanamke Female

Anwani Mkoa Wilaya Address: …….. Region: ……… District : ………….. Namba ya simu Namba ya “Sim Card” Namba ya utambuzi wa simu Number: ........................... SIM Serial: __________________ IMEI/ ESN______________________

UTAMBULISHO/ IDENTIFICATION Namba ya kitambulisho ID No. ____________ Aina ya kitambulisho: Type of ID:

Kimetolewa na Issued by ______________________________

Pasi ya kusafiria Leseni ya udereva Passport Driving Licence

Kitambulisho cha mpiga kura Voters ID card __________________________

Barua ya mtendaji Local government letter

Kitambulisho cha kazi Company ID

Vinginevyo Others

MAWASILIANO MENGINE(Kama Yapo)/ OTHER CONTACTS (If available) Namba ya simu: Anuani ya barua pepe Tel No. ____________________________ emai address_______________________________ Namba ya simu ya mkononi Mobile no. ________________________

S.L.B P.o. Box_ ____________________________

“Nathibitisha kuwa maelezo niliyotoa hapo juu ni ukweli mtupu na ninatambua kuwa nitawajibika kwa matumizi mabaya ya laini na namba” “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 sim card and number’’ Saini ya mteja Tarehe Sahihi ya mteja Customer’s Signature _____________ __________________ Tarehe Date _____________________

Amehudumiwa na: Sahihi Attended by________________________ Signature Mahali Location ___________________________