Agency Migration
Uploaded by
odhiamboelly21Agency Migration
Uploaded by
odhiamboelly21Agent System Migration Form
Section 1 (Mandatory to fill)
A. Please fill in the following details: (the form is deemed incomplete without these details)
Agency Name: Date
Name of the Branch: Agency Code
Agent Owner/Director’s Physical Address
Name
Contact Number
B. Outlet Details (Each outlet on separate form)
Outlet code
Outlet account no.
Terminal ID
Outlet Phone number (To be
used for login purpose)
C. User details
Full name of the Agent User
National ID of agent user
Outlet code/location
User Contacts
D. Channels applied (Tick where applicable)
Mobile App
Android POS
Web
USSD
Section 2 (Mandatory)
I hereby apply for migration of my agency data to Equity Business system.
I also declare that all the information provided herein is true to the best of my knowledge.
Agent Signature as per the account mandate
Name: Name:
Signature: Signature:
Name: Name:
Signature: Signature:
Name: Name:
Signature: Signature:
Section 3 (For Official Use Only)
This is to confirm that I have checked and verified that the information provided in this form is correct as
per the checklist below. I undertake all responsibility and due care of the data presented on this form.
Agent System Migration Request (Tick Each Box to confirm)
1. Agent System Migration request form is dully filled
2. The request is dully signed by the Agent Owner/Owners
3. Agent Signature is valid
4. Agent Signature is verified by Branch Management
5. Account is in the correct Scheme Code (SB126 OR CA 207)
6. Account is in the correct CIF(Transacting & Commission account)
7. Account Mandate is correct
Prepared by: Sign:
(Payment Supervisor)
Authorized by: Sign/Stamp:
(BGDM/Operations Manager)
