Gammacom New Client Application Form

You can complete this form by filling out the fields on screen. Once complete, please send it together with

  • Proof if identity for each authorized person
  • Proof of your company address (eg: utility bill, Rent bill, Bank Statement).

Company Information
Authorization
Primary

The client authorizes Gammacom to act on any instructions (Oral, written or electronic) given by the following named person(s).

Photo ID (Passport, Drivers License) is required for each authorized person listed.

Primary Authorized Contact

I declare that the information stated in the Authorized Person information is a true, complete and accurate record.

I acknowledge and agree that Gammacom may rely on such information for all purposes until Gammacom receives notification (in writing) from me of any changes.

Secondary

The client authorizes Gammacom to act on any instructions (Oral, written or electronic) given by the following named person(s).

Photo ID (Passport, Drivers License) is required for each authorized person listed.

Secondary Authorized Contact

I declare that the information stated in the Authorized Person information is a true, complete and accurate record.

I acknowledge and agree that Gammacom may rely on such information for all purposes until Gammacom receives notification (in writing) from me of any changes.

Tertiary

The client authorizes Gammacom to act on any instructions (Oral, written or electronic) given by the following named person(s).

Photo ID (Passport, Drivers License) is required for each authorized person listed.

Tertiary Authorized Contact

I declare that the information stated in the Authorized Person information is a true, complete and accurate record.

I acknowledge and agree that Gammacom may rely on such information for all purposes until Gammacom receives notification (in writing) from me of any changes.

Directors
Directors Information

We require at least two director agreements completed if your company has more than 2 directors.

In the event that 2 directors agreements cannot be obtained, we will require:

  • The Company CEO or;
  • The Company Secretary.

Director 1

I declare that the information stated in this form is true, complete and an accurate record.

I acknowledge and agree that Gammacom may rely on such information for all purposes until Gammacom receives notification (in wruiting) from me, of any change.

I have read, understood and agree the Gammacom terms and conditions of trade, and the Gammacom Rates and Terms.

I have read, understood and agree to be bound by the terms and conditions of the Gammacom Client Agreement and any addendum to the Client Agreement.

Director 2

I declare that the information stated in this form is true, complete and an accurate record.

I acknowledge and agree that Gammacom may rely on such information for all purposes until Gammacom receives notification (in wruiting) from me, of any change.

I have read, understood and agree the Gammacom terms and conditions of trade, and the Gammacom Rates and Terms.

I have read, understood and agree to be bound by the terms and conditions of the Gammacom Client Agreement and any addendum to the Client Agreement.

Complete Application
Complete Application

Please review your application and when you are happy that it is filled correctly, enter the security phrase below and click Send.