Securicom Messaging

New Purchase

Voucher/Sales Rep:

Activate SIM (If already provided):

First Name*:

Last Name*:

Date of Birth*:

Email Address*:

Address Line 1*:

Address Line 2:

City:

Province/State*:

Postal Code*:

ID Number*:

Alt Contact number:

Port existing number:

Port existing number:
** Only prepaid SIMs can be ported. If you are on a contract, convert to prepaid first.

Existing Service Provider
(If porting number):

Shipping:

Standard Shipping cost of R65.00 for the SIM Card will be added to the order.
Will arrange own collection

Proof Of Identity (*.jpg, *.png,*.bmp)

Proof Of Address (*.jpg, *.png,*.bmp)