Subscriber Application Form – New Connection

Order a new SIM
SIM Replacement/Upgrade For Upgrade, Lost, Faulty & Damaged
First name
Name as per NIC
Last name
Name as per NIC
078/072 Number
Alternate number
NIC Number
E-mail
Delivery address
Reason for Replacement/Upgrade
Identification Details
Select Number Preference

Select ID Type

NIC Number

*Allowed Image format PNG, JPEG
*Max Upload Size is 5MB

Terms & Conditions
Personal Details
First name
Name as per NIC
Last name
Name as per NIC
Contact number
Required to obtain Delivery time and date
Email
Required for order confirmation
Convenient calling time
Required to schedule appointment for delivery
Convenient Delivery day
Required to schedule appointment for delivery
Delivery Details
Permenant address
Delivery location
Delivery location
your image your image your image
Confirm & Submit