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1. SUBSCRIBER DETAILS PAYMENT METHOD: AGENT DETAILS

La ee AQUES MuLTICHOICE MultiChoice Africa Limited Registration Number 43308 C1 GBL SUBSCR APPLICATIO IBER N FORM SINGLE RESIDENTIAL UNIT ONLY SERIAL No m Sty so much more SMART CARD Mr Mrs Ms Initials SUBSCRIBER DETAILS Fax No Surname E Mail First Names Physical Address Identity No City
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5. SUBSCRIBER DETAILS PAYMENT METHOD: AGENT DETAILS

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Copyright Information Copyright 2006 Telsima Corporation 3945 Freedom Circle Suite 130 Santa Clara CA 95054 Rights Reserved This document is the property of Telsima and contains information protected by copyright laws The information in this document is subject to change without notice The information in this document is believed to be accurate and reliable However users must take full responsibility for their applications of any products specified in this document
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