MTN Mobile Money   

Agent Registration Form

   BUSINESS  DETAILS
Agent/Group Trade Name  
Business Registered Name  
Trade/ Business Registration Number  
Name Of Preferred Partner Bank  
Description Of Commercial Activities
 (Undertaken In Last 12 Months)
 
VAT Registration Number  
   BUSINESS LOCATION DETAILS
Street Address  
Suburb/Area City  
Postal Address
Country  
E-mail      
Telephone/Mobile No      
   SHOP MANAGER DETAILS
Surname  
First Name(s)  
Date Of Birth   DD/MM/YYYY
E-mail      
Telephone/Mobile No.       
TAX Identification Number  
Valid Photo ID  
Security Question (Choose One)  
Answer  
                                                     Agent Account Handler Registration Form
Title                                                             
Surname  
First Name(s)  
Initials
Maiden Name
Date Of Birth   DD/MM/YYYY
Country of Birth  
Place Of Birth  
Occupation  
  IDENTIFICATION
Identification Type  
ID Number                                                        
Marital Status  
Name of Spouse
Scanned Copy Of National ID           PDF files only
Scanned Copy Of Business Certificate           PDF files only
  RESIDENTIAL ADDRESS
House Number
Street                                                        
Suburb/Area
P.O.Box
City
Country  
Email   
Telephone/Fax    
Mobile Number      
Account Handler  
  MOBILE MONEY ACCOUNT OPERATION
Internet Username  
Type