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airtel SIM REPLACETqENT FORM

I
Full Names:

Mother's Maiden Name: Gender: Male Female

Nationality: State of origin: ......... Date of Birth: ...........

Alternate Phone number .....,..... NATTONAL IOENIIFICATION NUilEER (fltN):

Stolen Lost Damaged Sim Size change

DATA SIM

Last Recharge Details:

Date.....
Amount.

..,....-....,....1.........
4.
5.... 3................

Tts BYA
Prory lD Provtded
Full Name

Name of Bearer.

Alternate cdntact No. ....................

Unlocking Authoriratlon (if Applicable)
I confirm that the information on this form is true and accurate and I hereby indemnify all parties
that may act on the information
provided against any claim that may result from its use. I hereby
certify that I do have the relevant authority to authori2e the
unlock cif the line and I hereby indemnify and shall keep Airtel
indemnify against and to the full extent of any loss or damages that
may be occasioned by the incorrect unlocking of the said
line.

I . , . .. .......... hereby consent to the collection, processing, use and transfer

for the perfonnance of thts contract and any oin", Catn' processing of rny personal cjata
activities which may arise therefrom between myselF and
Airtel Netwo;KF L;mited (Airtei). taffirm thai f rrn a*aiu
of my rights under the relevani Data protection Laws in Nigeria and
olher terms detailed in the Data protection and privacy
Poiicy of Airtel available on https://airtel.com.ng/privacyipolicy.
I aulhorize and consent that any person who mav
be in possession of. or hereafier ecquire, any information pertaining
records may disclose sLch informatibn to Airtel to my

Signature & Date ................

FOR OFFICIAL USE ONLY:

Package: Prepaid postpaid Status of line: Active Suspended Cancelled

Place call to confirm status of line Customer/proxy rmage capture

lD card Validation of Customer.profile

/Oata s;m on CRM

I can confirm that I have checked the detailsprovided by the

customer.

Location Name,/ Deal Code.,.......... .... :. . .. _iigl;lulr Date..