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1 Step 1
AGENT ACCOUNT OPENING FORM
Please, note that all information supplied in this application is regarded as highly confidential but we reserve the right to discreetly investigate the claims therein. Submitting this form does not guarantee approval as a Super Dealer. Final decision will be communicated to you within two (2) weeks after completed submission.
1. Company Details
Company/Business Name
CAC / Certificate of incorporation / Registration Number
Date of incorporation
date_range
Type/Nature Of Business
Sector/Industry
Operating Business Addressmore details
0 /
Operating Business Address 2more details
0 /
Official Phone Numbers
phone
Corporate Tax Identification Number (TIN)
Website
Any other dealerships with existing TV Services/Communication Network? (Please tick)
Existing TV Service Provider or Communications Network
Dateof appointment
date_range
Monthly Turnoveryour full name
Annual Turnoveryour full name
2. Corporate Financial Details
Primary Bankers
Branchmore details
0 /
Account Name
Account Number
(BVN) Bank Verification Number
Minimum Expected Investment
Monthly Turnover (All Accounts/Banks)
Quarterly Turnover (All Accounts/Banks)
Annual Turnover (All Accounts/Banks)
Is your bank presently supporting/ funding your business operations?
If yes, please provide details
0 /
Please List Other Banks Where You Have Operational Accounts
0 /
3. Operational Details

Projected Subscribers

1st Month
1st Month
1st Quarter
6 Months
List of Preferred Distribution Coverage Area(s) - please list in order of preference
0 /
Number of Existing Agents
Total Required Agents
Warehouse Space (sq/m)
Operational Vehicles
Branches (if any
4. Contact Personnel Details
Prefix
Date of birthof appointment
date_range
Surname/Family Name
First Name/Given Name
Middle Name/Other Name
Contact Address/Residence
0 /
Primary Phone Number
call
Official Designation/Title
We attest that the information supplied in this document is accurate and reliable. We also authorise the above-identified contact as our official representative in all transactions with Pipul TV. We understand that this application may be disqualified due to falsified data
Chairman or CEO
Authorised Representative
Company Secretary
Date
date_range
DEALERSHIP PREQUALIFICATION REQUIREMENTS
Please submit this form along with photocopies of:

Download the Agreement form, fill it and upload along with other corporate documents

Fileupload
cloud_uploadUpload Official Corporate Documents (CAC, National ID etc.)
_________________________________________
Fileupload
cloud_uploadUpload Passport of the authorised contact personnel with a clear or white background
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