Enterprise Number Porting Consent Form

Enterprise Details

Enterprise Name

Account Number

Enterprise Address

Current Service Provider Details

Current Provider Name

Service Type

Provider Account Number

Numbers to be Ported

List Number(s) to be Ported

Authorised Representative

Name

Position/Title

Contact Number Email Address

Consent & Declaration

I hereby consent to port the above listed number(s) to the new service provider. I confirm that I’m authorised to request this porting and all provided information is accurate.

Signature

Date