Pseudo-NNI

First name* :

Last name* :

Birth date*:

Birth department number*:

Gender* : – Select –FM

ID Group (G2S) :

Geographic location* :
NNI location*:

Model NNI:

Shared name directories:

External

External* :– Sélectionner –OuiNon

Start date:

End date:

Company (provider):

Beneficiary manager:

Workstation

Workstation to be ordered*: – Sélectionner –OuiNon

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

If reassignment, PC reference:

Contact person for PC appointment:

Workstation to be ordered*: – Sélectionner –OuiNon

Shared directory names :

Mobile

Mobile service*: – Select –OuiNon

Existing mobile line to be reassigned:

Current operator:

Former beneficiary entity:

Operator code:

Operator: – None –BouyguesOrangeSFR

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

10Go default plan, if other specify:

Package recipient NNI:

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

Delivery address:

Landline

Landline service* :– Select –OuiNon

Existing landline to be reassigned:

International access:– None –OuiNon

Workstation supply:– None –OuiNon

Location:

Contact person for the appointment:

(*) Required field