AGENTLI

NEAPPLI
CATI
ONFORM

*
*Agent
/busi
nessname …………………………………………………………………………………………………

*
*Cont
actper
son ……………………………………………………………………………………………………………….

*
*Cont
actnumber ………………………………………………………………………………………………………………

*
*Regi
on/
Prov
ince:………………………………………………………………………………………

**
Town:…………………………………………………………………………………………………………………. .
Agentl
inedet
ail
s(Not
e:MAXI
MUM of6l
ines&MI
NIMUM of2l
inesperf
orm):

*
*Physi
calLocati
onWher e **
Tradi
ngSpace( MTN
AgentLi
neWi l
lOperat
e Ki
osk,Shop,Sel
f-
made
No. *
*MSI
SDN (Town&Ar ea/Market
) kiosk)
PARENTLINE(
FirstTi
me
Appl
i
cat
ion)
1
2
3
4
5

NOTE–

1. Agentli
nesappl iedformustONLYoper ate/t
ransacti narea/
mar ketindicatedabove.Anyagentline
foundinanyar ea/mar ketcontr
arytothi
sappl i
cat i
onwillbedeactivatedwi thimmediat
eeffectunti
l
sit
uati
onisnor mal i
sed.
2. Agentli
nemustt radeint hespaceindi
catedint ableabovei.
e.MTNKi osk,shoporself
-madekiosk.
Anyagentl i
nef oundtradinginanyspacecont rarytothisappli
cationwi llbedeact
ivat
edwith
i
mmedi ateeffectunt i
lsit
uationisnormali
sed.
3. Areasmar kedwi th**aremandat oryfi
eldstobef il
ledinforsuccessfulpr ocessi
ngofagentline
appli
cati
onandcr eati
on.

*
*Agentsi
gnat
ure(
Aut
hor
isedSi
gnat
ory
):………………………………………………………………….

*
*Dat .2020
e: ……………………………………………….

APPROVAL:MTNMOBI
LEMONEYOFFI
CALS

FULLNAMES SI
GNATURE DATE

1.TDR ………………………………………. ……………………… ………………………….

2.RTL ……………………………………….
. ……………………… …………………………

3.Regi
onalSal
esRep ………………………………………. ……………………… ……………………….
.

4.Ret
ailManager ………………………………………. ………………………. …………………………….

5.H.
O.D ………………………………………. ………………………… …………………………….