Etisalat Nigeria SIM Swap

Please fill out the application form, ensuring a clear description of your product/service or idea is given.
With a project document or business plan file attached.


CUSTOMER INFORMATION
Kindly fill out the form below and click on the submit button. You will be required to confirm the provided information, after which you click on 'continue' for the information to be submitted. The fields marked * are mandatory.
Title:
First Name:	*
Last Name:	*
E-mail Address:	*
Alternative number(s) Please provide an alternative phone number on which you can be reached during the day.	*
INFORMATION ON OLD SIM (STOLEN/LOST/DAMAGED)
Was your Etisalat line:	Stolen? Lost? Damaged?
Enter the phone number of the stolen/lost/damaged line	*
PLEASE PROVIDE THE FOLLOWING INFORMATION CAREFULLY (proceed to the next set of questions if you are able to answer only 2 of the questions)
PUK number on old SIM pack	*
How much credit did you load when you last recharged?	*
The date of birthday provided during SIM registration:	Day / Month *
PLEASE PROVIDE ANSWERS TO ANY 4 QUESTIONS BELOW
What 3 GSM numbers do you frequently dial? please insert the full phone number e.g 0809000000	*
	*
	*
Residential address provided during sim registration	*
State of origin provided during sim registration	*
Local Government Area of origin provided during sim registration	*
Your registered 'You' and 'Me' number (if any)	*
Local Government Area of residents provided during sim registration	*
Mother's maiden name if it was not provided during sim registration	*
Package type eg EasyCliq, Easy Starter, etc	*
INFORMATION ON NEW LINE TO BE USED FOR THE SWAP
Please provide the number of the new line that you bought for this SIM SWAP	*
Please provide the serial number of the new line that you bought for this SIM SWAP. Remember that the Prepaid line has to be new, which you have NOT yet inserted into a handset. Phone number of the new line, starting with 0809, 0817 or 0818.		*

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