Claimant name*:

Claimant email*:

Beneficiary NNI*:

Beneficiary email*:

Operator*:– Select –BouyguesOrangeSFR

Smartphone type*:– Select –Classique androidPrémium androidPrémium appleSmartphone durci (métier exploitation)

Delivery address*:

10Go default plan, if other specify:

Consignee NNI of the package:

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

Existing mobile line to be reassigned:

Current operator:

Former beneficiay entity:

Operator Code:

(*) Required field