Beneficiary

Beneficiary first name*:

Beneficiary last name*:

Beneficiary NNI*:

NNI location*:

Workstation

Workstation to be ordered*: – Select –OuiNon

Workstation type: – None –FixeFixe scientifiquePortablePortable boostéPortable scientifiquePortable scientifique ultraléger

If reassignment, PC reference:

Contact person for PC appointment:

Office account to be created* : – None –OuiNon

Shred directory names:

Mobile

Mobile service*: – Select –OuiNon

Mobile number to be reassigned:

Current operator:

Former beneficiary entity:

Operator code:

Operator: – None –BouyguesOrangeSFR

International voice option (outside Europe): – None –OuiNon

10GB default plan, if other specify:

NNI destinataire du colis :

Smartphone type: – None –Classique androidPrémium androidPrémium appleSmartphone durci (métier exploitation)

Address delivery:

Landline

Landline service*:– Select –OuiNon

Ligne fixe existante à réaffecter :

International access:– None –OuiNon

Workstation forniture:– None –OuiNon

Location:

Contact person for the meeting:

(*) Required field