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|pLot Bsmart CSia eee comets nan reer es BUSINESS CUSTOMER INFORMATION FORM To be filled out by the Customer J Perret TASIC CUSTOMER FORMATION Registered Business Namex/ fen pret [Store/Shop/Outlet Name/Trade Name: sons nal nse ey iting ies tern ron Bnet Airs) fone reece Vi osc numb of a acpi hr ei Ades Reet * uses Owners: 1 Prvate LU Government ex VAT Exempt Zero Rates Twa var Fy Others. pease specty SccRegratonne (comoany TW "AUTHORIZED SIGNATORY INFORMATION [area atone Fostion and Ena Aes (Contact No analog We B MOET 1D Company 0; 10 No, __ 1 Passport 1D No Driers License 10 No 1D SS8I6SIS 10:10 No ‘ORGANIZATION DATA oT rns econ) TY SGLE PROPRIETORSHIP Tr PARTNERSHIP [CORPORATION ome ofregseaton: To. of Employee St asin Operation Ta Presa TR "leshone “OIE PROPRIETOR DSCIOSURE | hereby declare thot all the above information are true ond correct to my own knowledge. hereby authorite PLOT/SMART/SUN to very any ofthe above ‘siven information from whatever source it may consider appropriate. Any misrepresentation on the above Information shall constitute o just cause forthe rejection ‘f my opplication or the termination of my contract with the Company. v uth Snatr/ienoture above 9c ver? with 0Pa_02052018 |

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