BOK Mobile Money Account Level Form Final

«‫ ﺧﺪﻣﺔ اﻟﺪﻓﻊ ﻋﺒﺮ اﻟﻤﻮﺑﺎﻳﻞ »ﺑﻨﻜﻚ‬- ‫اﺳﺘﻤﺎرة ﺗﻌﻠﻴﺔ اﻟﺤﺴﺎب‬
Mobile Money Account - Level Upgrading Form
Request Date ‫ﺗﺎرﻳﺦ اﻟﻄﻠﺐ‬
Mobile Numbers 2 4 9 ‫رﻗﻢ اﻟﻤﻮﺑﺎﺑﻞ‬
Email Address ‫اﻟﻌﻨﻮان اﻟﺒﺮﻳﺪي‬
Registration Date ‫ﺗﺎرﻳﺦ اﻻﺷﺘﺮاك ﻓﻲ اﻟﺨﺪﻣﺔ‬
Existing BOK A/C – CIF (if available) (‫رﻗﻢ اﻟﺤﺴﺎب اﻟﻤﺼﺮﻓﻲ )ان وﺟﺪ‬
Branch Name ‫اﺳﻢ اﻟﻔﺮع‬
National ID ‫اﻟﺮﻗﻢ اﻟﻮﻃﻨﻲ‬
Full Name ‫اﻻﺳﻢ ﺑﺎﻟﻜﺎﻣﻞ‬
First Name ‫اﻻﺳﻢ اﻻول‬
Second Name ‫اﻻﺳﻢ اﻟﺜﺎﻧﻲ‬
Third Name ‫اﻻﺳﻢ اﻟﺜﺎﻟﺚ‬
Family Name ‫اﻻﺳﻢ اﻟﺮاﺑﻊ‬
Gender: [ ] Male [ ] Female ‫ ] [ ذﻛﺮ ] [ أﻧﺜﻰ‬:‫اﻟﻨﻮع‬
Birth Date ‫ﺗﺎرﻳﺦ اﻟﻤﻴﻼد‬
Place Of Birth ‫ﻣﻜﺎن اﻟﻤﻴﻼد‬
Birth Country ‫دوﻟﺔ اﻟﻤﻴﻼد‬
Mother Name ‫اﺳﻢ اﻻم‬
Residential Address ‫ﻣﻜﺎن اﻟﺴﻜﻦ‬
Profession ‫اﻟﻤﻬﻨﺔ‬
‫ﻣﻜﺎن اﻟﻌﻤﻞ‬
Education Level ‫اﻟﻤﺴﺘﻮى اﻟﺘﻌﻠﻴﻤﻲ‬
Choose Level Of Mobile Money Account : Silver ‫اﻟﻔﻀﻲ‬ :‫اﺧﺘﺮ ﻧﻮع ﺣﺴﺎب اﻟﺪﻓﻊ ﻋﺒﺮ اﻟﻤﻮﺑﺎﻳﻞ‬
Reason Of Change Mobile Money Account Level: :‫ﺳﺒﺐ ﺗﻐﻴﻴﺮ ﻧﻮع ﺣﺴﺎب اﻟﺪﻓﻊ ﻋﺒﺮ اﻟﻤﻮﺑﺎﻳﻞ‬
Terms and Condition of Upgrading ‫ﺷﺮوط وأﺣﻜﺎم ﺗﻌﻠﻴﺔ ﺧﺪﻣﺔ ﺑﻨﻜﻚ‬
Mobile Money Accounts Level ‫ﻟﺤﺴﺎﺑﺎت اﻟﺪﻓﻊ ﻋﺒﺮ اﻟﻤﻮﺑﺎﻳﻞ‬
1. These terms are subject to all terms and conditions ‫ﺗﺨﻀــﻊ ﻫــﺬه اﻟﺸــﺮوط ﻟﻜﺎﻓــﺔ ﺷــﺮوط وأﺣــﻜﺎم ﺧﺪﻣــﺔ اﻟﺪﻓــﻊ‬ .1
of the Mobile Money Payment Service issued by the
service provider and shall be interpreted in accordance
with the Sudanese laws and the regulations issued by ‫ﻟﻠﻘﻮاﻧﻴــﻦ اﻟﺴــﻮداﻧﻴﺔ واﻟﻀﻮاﺑــﻂ اﻟﺼــﺎدرة ﻣــﻦ اﻟﺒﻨــﻚ اﻟﻤﺮﻛــﺰي‬
the Central Bank for mobile money payment services
and subject to the exclusive jurisdiction of the Sudanese .‫اﻟﻘﻀﺎﺋــﻲ اﻟﺤﺼــﺮي ﻟﻠﻤﺤﺎﻛــﻢ اﻟﺴــﻮداﻧﻴﺔ‬
courts.
‫ ﻳﻠﺘــﺰم اﻟﻌﻤﻴــﻞ ﺑﺘﻘﺪﻳــﻢ ﻣــﺎ ﻳﺜﺒــﺖ ﻣﻠﻜﻴﺘــﻪ ﻟﻠﺸــﺮﻳﺤﺔ وإﺣﻀــﺎر‬.2
2. The customer is obliged to provide proof ownership
SIM Card issued from one of the accredited
telecommunications companies in the Republic of .‫ﺑﺠﻤﻬﻮرﻳــﺔ اﻟﺴــﻮدان‬
Sudan.
‫اﻟﻤﻘﺪﻣــﺔ ﺑﺎﻟﻨﻈــﺎم‬
ّ ‫ ﻳﻘــﺮ وﻳﻮاﻓــﻖ اﻟﻌﻤﻴــﻞ ﺑــﺄن اﻟﻤﻌﻠﻮﻣــﺎت‬.3
3. The Customer acknowledges and agrees that all
information provided for the purpose of upgrading
Mobile Money accounts Level are true/correct and ‫ﻫــﻲ ﻣﻌﻠﻮﻣــﺎت ﺻﺤﻴﺤــﺔ وﺣﻘﻴﻘﻴــﺔ وﻳﺘﻌﻬــﺪ اﻟﻌﻤﻴــﻞ ﺑﺘﻮﻓﻴــﺮ‬
authentic. The customer undertakes to provide and
disclose any information required by the Service
Provider from time to time for continuity of service
and agree that the Service Provider will exchange this ‫ﻋﻠــﻰ أن ﻳﻘــﻮم ﻣﻘــﺪم اﻟﺨﺪﻣــﺔ ﺑﺘﺒــﺎدل ﻫــﺬه اﻟﻤﻌﻠﻮﻣــﺎت ﻣــﻊ‬
information with the Service Provider.
.‫ﻣــﺰود اﻟﺨﺪﻣــﺔ‬
4. The customer exempts the Service Provider from any
liability for using the information disclosed by the ‫ ﻳﻌﻔــﻲ اﻟﻌﻤﻴــﻞ ﻣﻘــﺪم اﻟﺨﺪﻣــﺔ ﻣــﻦ أي ﻣﺴــﺌﻮﻟﻴﺔ ﻋﻨــﺪ‬.4
customer for the purpose of using the service through ‫إﺳــﺘﺨﺪام اﻟﻤﻌﻠﻮﻣــﺎت اﻟﺘــﻲ أﻓﺼــﺢ ﻋﻨﻬــﺎ اﻟﻌﻤﻴــﻞ ﺑﻐــﺮض‬
the system and conducting transactions.
.‫إﺳــﺘﺨﺪام اﻟﺨﺪﻣــﺔ ﻋﺒــﺮ اﻟﻨﻈــﺎم وإﺟــﺮاء اﻟﻤﻌﺎﻣــﻼت‬
5. The Customer acknowledges and agrees that the use
of the Service through the System is subject to the ‫ ﻳﻘــﺮ وﻳﻮاﻓــﻖ اﻟﻌﻤﻴــﻞ وﻳﻌﻠــﻢ ﺑــﺄن إﺳــﺘﺨﺪام اﻟﺨﺪﻣــﺔ ﻋﺒــﺮ‬.5
conditions of the Service Provider and other regulatory/ ‫اﻟﻨﻈـﺎم ﺧﺎﺿـﻊ ﻟﺸـﺮوط ﻣـﺰود اﻟﺨﺪﻣـﺔ واﻟﺴـﻠﻄﺎت اﻟﺘﻨﻈﻴﻤﻴـﺔ‬
governmental authorities issued from time to time.
‫ﺑﺘﻮﻗﻴﻌــﻲ ﻋﻠــﻰ ﻫــﺬا اﻟﻄﻠــﺐ ﺑﻤﺜﺎﺑــﺔ إﻗــﺮار ﻣﻨــﻲ ﺑــﺄن ﺟﻤﻴــﻊ‬

By signing this application, I certify that all documents
submitted to the Service Provider are updated, correct/ ‫اﻟﻮﺛﺎﺋــﻖ اﻟﻤﻘﺪﻣــﺔ ﻟﻤﻘــﺪم اﻟﺨﺪﻣــﺔ ﻫــﻰ ﺣﺪﻳﺜــﺔ وﺻﺤﻴﺤــﺔ‬
true and binding. If any of the documents submitted are ‫ ﻓــﻲ ﺣــﺎل إﻧﻘﻀــﺎء أو ﻋــﺪم ﺻﺤــﺔ أي ﻣــﻦ ﻣــﻦ‬،‫وﻣﻠﺰﻣــﺔ‬
expired or incorrect, it will be my sole responsibility to ‫اﻟﻤﺴــﺘﻨﺪات اﻟﻤﻘﺪﻣــﺔ ﻓﺴــﻴﻜﻮن ﻣــﻦ ﻣﺴــﺆوﻟﻴﺘﻰ اﻟﻤﻨﻔــﺮدة‬
provide the Service Provider with immediate updates ‫ﺗﺰوﻳــﺪ ﻣﻘــﺪم اﻟﺨﺪﻣــﺔ ﻋﻠــﻰ اﻟﻔــﻮر ﺑﺘﺤﺪﻳــﺚ اﻟﻤﻌﻠﻮﻣــﺎت‬
of information and submitted documents. I also agree
‫ ﻛﻤــﺎ أﻗــﺮ ﺑﺈﻋﻔــﺎء ﻣﻘــﺪم اﻟﺨﺪﻣــﺔ‬.‫ﻣــﻦ اﻟﻤﺴــﺘﻨﺪات اﻟﻤﻘﺪﻣــﺔ‬
to exempt the Service Provider from any liability that
‫ﻋــﻦ أي ﻣﺴــﺌﻮﻟﻴﺔ ﻗــﺪ ﺗﻨﺸــﺄ ﺟــﺮاء ﻓﺸــﻠﻲ ﻓــﻲ ﺗﺤﺪﻳــﺚ‬
may arise as a result of my failure to update requested
information. .‫اﻟﻤﻌﻠﻮﻣــﺎت وأﻧﻨــﻲ أﺗﺤﻤــﻞ ﻛﺎﻓــﺔ اﻟﻤﺴــﺆوﻟﻴﺔ‬
Name: ……………………………………………… ……………………………………………………………………… :‫اﻻﺳﻢ‬

Signature: ……………………………….……….... …………………………………………………………………… :‫اﻟﺘﻮﻗﻴﻊ‬
Date: ……………………………………………….. ……………………………………………………………………… :‫اﻟﺘﺎرﻳﺦ‬
Staff Name: ………………………………………... ...........................................................................................:‫اﺳﻢ اﻟﻤﻮﻇﻒ‬

Staff ID:……………………………………….. ......................................................................................:‫اﻟﺮﻗﻢ اﻟﻮﻇﻴﻔﻲ‬
[ ] Attach ID copy ‫] [ اﺳﺘﻼم ﻧﺴﺨﺔ ﻣﻦ اﻟﺮﻗﻢ اﻟﻮﻃﻨﻲ‬
[ ] Attach the telecom proof of SIM ownership ‫] [ اﺳﺘﻼم اﺛﺒﺎت ﻣﻦ ﺷﺮﻛﺔ اﻻﺗﺼﺎل ﻋﻠﻰ ﻣﻠﻜﻴﺔ اﻟﺮﻗﻢ‬

BOK Mobile Money Account Level Form Final

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«‫ ﺧﺪﻣﺔ اﻟﺪﻓﻊ ﻋﺒﺮ اﻟﻤﻮﺑﺎﻳﻞ »ﺑﻨﻜﻚ‬- ‫اﺳﺘﻤﺎرة ﺗﻌﻠﻴﺔ اﻟﺤﺴﺎب‬

Mobile Money Account - Level Upgrading Form

Request Date ‫ﺗﺎرﻳﺦ اﻟﻄﻠﺐ‬

Mobile Numbers 2 4 9 ‫رﻗﻢ اﻟﻤﻮﺑﺎﺑﻞ‬

Email Address ‫اﻟﻌﻨﻮان اﻟﺒﺮﻳﺪي‬

Registration Date ‫ﺗﺎرﻳﺦ اﻻﺷﺘﺮاك ﻓﻲ اﻟﺨﺪﻣﺔ‬

Branch Name ‫اﺳﻢ اﻟﻔﺮع‬

National ID ‫اﻟﺮﻗﻢ اﻟﻮﻃﻨﻲ‬

Full Name ‫اﻻﺳﻢ ﺑﺎﻟﻜﺎﻣﻞ‬

First Name ‫اﻻﺳﻢ اﻻول‬

Second Name ‫اﻻﺳﻢ اﻟﺜﺎﻧﻲ‬

Third Name ‫اﻻﺳﻢ اﻟﺜﺎﻟﺚ‬

Family Name ‫اﻻﺳﻢ اﻟﺮاﺑﻊ‬

Gender: [ ] Male [ ] Female ‫ ] [ ذﻛﺮ ] [ أﻧﺜﻰ‬:‫اﻟﻨﻮع‬

Birth Date ‫ﺗﺎرﻳﺦ اﻟﻤﻴﻼد‬

Place Of Birth ‫ﻣﻜﺎن اﻟﻤﻴﻼد‬

Birth Country ‫دوﻟﺔ اﻟﻤﻴﻼد‬

Mother Name ‫اﺳﻢ اﻻم‬

Residential Address ‫ﻣﻜﺎن اﻟﺴﻜﻦ‬

Education Level ‫اﻟﻤﺴﺘﻮى اﻟﺘﻌﻠﻴﻤﻲ‬

‫ﺑﺘﻮﻗﻴﻌــﻲ ﻋﻠــﻰ ﻫــﺬا اﻟﻄﻠــﺐ ﺑﻤﺜﺎﺑــﺔ إﻗــﺮار ﻣﻨــﻲ ﺑــﺄن ﺟﻤﻴــﻊ‬

Name: ……………………………………………… ……………………………………………………………………… :‫اﻻﺳﻢ‬

Staff Name: ………………………………………... ...........................................................................................:‫اﺳﻢ اﻟﻤﻮﻇﻒ‬

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