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Recharge Agreement Form

In continuation of Agreement Form I hereunder furnish particulars of my Credit Card, which may be used for payment recoveries under the said agreement. All conditions set out in the said agreement will apply to usage of this credit card. I also authorise Uniconnect SIM Pvt. Ltd. to take necessary debits and / or authorisations at any point of time. I confirm having received the call charges tariff statement for the various countries I am travelling to.

Mobile No*


Name*
Card Type*
Card Number*
Expiry Date*
CVV *
Credit Card Issuing Bank Name *
Credit Card Billing Address*
Email*
 
Mobile Number*
Residence Number*
Office Number*


 I agree read and agree with above terms & conditions. AGREE & Authenticate Credit Card


*Rs. 5 will be debited to the Credit Card to authenticate this transaction, you’ll need to re-enter the above details in the payment gateway
(next screen) to complete authentication.