Consumer Contract and Services Cancellation/Retention Request Agent to complete Agent name A Ccmleted form to be conto Fed Services| Noble Series Eat assress:cencancelaton@teltomcoza Contact: 10210 nat sadres Cancokatons@sekomcoza Contacto: 061 180, Fox n.Og6 031-503 3505 NOTE A sence consltont wil centoct you to vey the information provided andjor cnr concelatenretenton options avaieble ‘Supporting documentation, > pout ef ucoun holders entiation ar duly authored person’ entiation copy of SAID or passp0" Copy trecupt for CPx cancnlouons wha dence ete 2 Cepdordeathcerttieas UF apoteabla) meee We me Sumame Ssh Frestramas sh rDoa/bscsper'na. 2/8/90 o2}z | | | Yowekomaccountne, 9/3 4 2 0)2, 9/9 2 ternative contacto. | Firalirwoce Ema J Emaladdess eshargh@owttcom post Posladess Un72, eet Wigs, 18 Bra sot, Svbutb Mah ey [Comin Postcode [0 13) 7) EEE SenvicefProduct Service ne, Mave(Por to another service provider je 2.5/7/6 7/s 4/6 FRO ee Select the ey reason(s) for cancelation ‘ustomerexpererce Voice Sroadband ‘customer affordabitty catcerteseice | clink Somitemet Noergmrtedsevenprotit, | Lerefeare sivesenie |= Gteatmalworrcsa cts mmo cenes| Nocomrgeaamlccton —_—_ necheneyoniupcy tng Dropped Noremokenge Y expats pases eaprceseo eee nie anes ‘To many ts odour yen deve sate fem enter eet newer comrane Sitch woneterTekenslaen send What can Telkom do to retain your service? = eee eee Devicereumed Yes | No ¥) —SWMeardrctumed Yes | Nov) SetayCooing-oft Yes | | No| ernrionstwh nnn) Device make & model | s condition of device | 1 swserna[ ICCD 00. service 9.1 TED D LT) Service ne.2 T) Sorwesne.3 dona comments |.the undersigned, deciare, agree ané confirm thet: 1Lthave ead undestond and agree o be bound by Tlkoms standard terms and conditions forthe Provision of Electronic Communication Services ahd Sroducts swe as Tekoms moble subsenber terms and condtions both avaabe ot Mfr telkom.cozo/stes/sbeutulregutorul {ermanccondtions. 2 Stancard written rate petad apples in ers of changes to Telhom products and sarices. 5inthe cose of services rented in trms of contrac agreement. ho ronal bligauors are govered bythe condions ofthe evant agreement and ‘pens f applsbl, wl pol «4 fmauly scthoneed ta gn on Behalf ofthe account Mode, The nfrmationprouded on ths form sve er cores. lp Signature Fullname Riss Seok Sire Desiae name Dealer code [ Agent name Signauze a oe OOOO OTE ae ee ts abcde te Vie Sam ex tend mat cp the ian cei Visine