Datec Fiji - COD Application Form

SECTION A Company Details
Registered Company Name :
Date Company Registered:
Nature of Business:
Address - Registered Office:
Postal Address:
Business Contact Number:
Business Mobile Number:
Business Email:

Accountant Full Name:
Accountant Email:
Accountant Mobile / Phone:

SECTION B Director's Names and Addresses
Directors Full Name:
Directors Phone/Mobile:

Directors Email:
SECTION C Bank Details
Bank Name:
Branch:
Bank Account Number:
SECTION D Terms and Conditions
Attach Business License:
I/we certify that the details in this form are true and correct and that I/we whose signature(s) appear below are identical to the names and person(s) mentioned above:	Yes

COD Application Form