Subscription Form
‫طﻠب اﻹﺷﺗراك‬
:‫رﻗﻢ اﻟﻌﻘﺪ‬
Contract Number: 1008459728
:‫رﻗﻢ اﻟﻨﻘﺎل‬
50330446
Phone Number:
DD
14
Date:
:‫ﻧﻮع اﻻﺷﺘﺮاك‬
Type of Subscription: POST VOICE
MM
01
YYYY
2019
:‫ﻧﻮع اﻟﺮﻗﻢ‬
Number Type: GOLDEN
:‫اﻟﺘﺎرﯾﺦ‬
Customer Data
First Name:
‫وﻟﯿﺪ‬
:‫اﻻﺳﻢ اﻷول‬
Middle Name:
‫ﺳﯿﺪ‬
:‫إﺳﻢ اﻷب‬
Surname:
‫ﻣﺤﻤﺪ‬
DD
30
Date of Birth:
MM
05
YYYY
1989
‫ﺑﯿﺎﻧﺎت اﻟﻌﻤﯿﻞ‬
:‫ﺗﺎرﯾﺦاﻟﻤﯿﻼد‬
:‫اﻟﺠﻨﺴﯿﮥ‬
Nationality: EYGPT
:‫إﺳﻢ اﻟﻌﺎﺋﻠﮥ‬
:‫اﻟﺠﻨﺲ‬
Gender: M
ID Number: 290037005222
:‫رﻗﻢ اﻟﺒﻄﺎﻗﮥ‬
Other Contact Number : 50119254
:‫رﻗﻢ آﺧﺮ ﻟﻠﻌﻤﯿﻞ‬
ID Type: Civil ID
:‫ﻧﻮع اﻟﺒﻄﺎﻗﮥ‬
Email:
:‫اﻟﺒﺮﯾﺪ اﻹﻟﮑﺘﺮوﻧﯽ‬
:‫اﻟﻌﻨﻮان‬
Address:
KD
30
.‫ك‬.‫د‬
Package
:‫ﺗﻔﺎﺻﯿﻞ اﻟﺒﺎﻗﮥ‬
Package Details:
‫ﺗﻔﺎﺻﯿﻞ اﻟﺨﺪﻣﮥ‬
Action
‫ﺑﺎﻗﮥ اﻟـ‬
Service Details
‫اﻟﺴﻌﺮ‬
Price
‫ﻓﺘﺮة اﻻﻟﺘﺰام‬
Commitment Period
‫اﻟﺮﻗﻢ اﻟﺘﺴﻠﺴﻠﯽ‬
Serial No.
Add
MONTHLY 30
30
Add
24-month Commitment
0
Add
Free Surf On 18
0
Add
APPLE IPHONE XR 64GB BLACK
0
357359098483935
SIM CARD 01
2
040109700128
24
‫رﺳﻮم اﻹﻟﻐﺎء‬
Penalty Fees
220
I, the undersigned, read and accept the terms and conditions mentioned in the subscription form.
‫ ﺑﺎﻻﻃﻼع ﻋﻠﻰ اﻟﺸﺮوط واﻻﺣﮑﺎم اﻟﻤﺬﮐﻮره ﻓﯽ ﻧﻤﻮذج اﻻﺷﺘﺮاك واﻟﻤﻮاﻓﻘﮥ ﻋﻠﯿﻬﺎ‬، ‫أﻗﺮ اﻧﺎ اﻟﻤﻮﻗﻊ ادﻧﺎه‬.
Employee Name
MALIK JURAYED AL-SUWAIT
Date
14/01/2019
Customer Signature
‫اﺳﻢ اﻟﻤﻮﻇﻒ‬
‫آﻟﺘﺎرﯾﺦ‬
Fingerprint
www.viva.com.kw
Agent Signature
Please only sign inside the box
Olympia, Main Office Mall Floor 5-20 Al-khansa Street, Salmiya Area, P.O.Box 181 KUWAIT CITY T: +96555102102
SL - F ٠٧