SIM Card Request Form

SIM Card Request Form
This application form is designed to help stores request new or additional SIM cards, replace existing SIM cards through a SIM swap, or cancel SIM cards.
Please review the available options and associated fees before submitting your request.

What would you like to do?*
Please select the option that best describes your request:

Order a new SIM card – A new SIM card will be issued.
Applicable fees: New SIM Card Fee + Courier Fee

Request a SIM swap – Replace a lost, stolen, or damaged SIM card
Applicable fees: SIM Swap Fee + New SIM Card Fee + SIM Processing Fee + Courier Fee

Cancel a SIM card* – Request the cancellation of an existing SIM card.
Applicable fees: SIM Swap Fee + SIM Processing Fee

Fee Description - Amount
New SIM Card Fee - 8.85
SIM Swap Fee - 97.00
SIM Processing Fee - 240.00
Courier Fee Varies depending on the courier service

Please note:
- All applicable fees will be charged based on the service selected.
- Courier fees vary depending on the courier service used.
- Please ensure that you select the correct option to help us process your request efficiently.
I accept the above fees *
If you know the SIM card serial number, please enter it below below or select 'I do not know the SIM serial number':
Please enter the SIM number below:

SIM Card Request Form
Which mobile network will you be using for your SIM Cards
How many SIM cards would you like to order?
Additional SIM cards are only needed if you are ordering additional hardware or replacing missing hardware. Cosoft manages the data on your SIM cards so you never need worry about topping up or running out.

SIM Card Request Form
Protection Of Personal Information (POPI)

The personal information you provide on this form will be stored on Jotforms’ servers. It will be used by Cosoft to email your quote to you, phone you to arrange the installation or ask for more information in order for us to quote or to send a technician to your site. It may also be used to SMS you on important progress updates. This information is deleted after 12 months, but a copy of it will continue to exist as a record on Cosoft’s other internal systems. None of this information will ever be shared with a 3rd party unless we need to in order to execute our operations. Examples of this are sharing information with integrators such as FNB for your Pinpad or Delivery Tribe for your driver application. Your information will not be sold or shared or used by 3rd parties for the purposes of marketing campaigns.

You can read our full Privacy Policy here: http://www.cosoft.co.za/sites/default/files/Privacy-Policy-Cosoft-V2.pdf
Contact Details
Brand
Store Name
Owners Name

First NameLast Name
Owners Email
example@example.com
Owners Mobile Number
Please enter a valid phone number.Format: (000) 000-0000.
Are you the owner?
Your Name

First NameLast Name
Your Email
If different from owner's email address.
Your Mobile Number
Format: (000) 000-0000.
Store's Phone Number
Format: (000) 000-0000.
SIM Card Delivery Address
Brand Franchise Manager's Name

First NameLast Name
Brand Franchise Manager's Email
Should be Empty:

Contact Details