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Please fill in the required information to create a sign up to become a member of KEP.
General Information
Request Number
Title *
Mr.
Mrs.
First Name *
Last Name *
Gender *
Female
Male
Marital Status *
Divorced
Married
Single
Widowed
Work Information
Company Name *
Company Address *
Company Phone *
Role/Function *
Department *
Bank Information
Bank Name *
ACU
Banco di Caribe
Citco
First Caribbean Bank
MCB
ORCO
Other
PSB
RBC
Vidanova
Bank Account *
Other Bank Name
ACU
Banco di Caribe
Citco
First Caribbean Bank
MCB
ORCO
Other
PSB
RBC
Vidanova
Other Bank Account
Member Information
ID Number *
ID Type
ID Card (Sedula)
Birth Date (YYYY-MM-DD) *
Birth Place (e.g. Willemstad, Curacao) *
Required Documents
ID (Sedula) Document *
Work Letter Document *
Proof of Residence Document *
Contact Information
Mobile Phone Number (e.g. 59995661234) *
Home Phone Number (e.g. 59994661234)
Work Phone Number (e.g. 59995661234)
Other Phone Number (e.g. 59995661234)
Home Address *
Email *
Financial Information
First Payment Date (YYYY-MM-DD) *
Akshon Amount (Multiples of 25 ANG) *
Deposito Amount (Multiples of 25 ANG) *
Sparplan Hubenil Amount (Multiples of 25 ANG) *
Family Indemnity Plan
Plan A: 26.40 ANG per Month (5.000 ANG)
Plan B: 39.60 ANG per Month (7.500 ANG)
Plan C: 52.80 ANG per Month (10.000 ANG)
Plan D: 79.20 ANG per Month (15.000 ANG)
Chippie Company Package
Deal 1: 20GB Data (ANG 99.00)
Deal 2: 35GB Data (ANG 149.00)
Deal 3: 50GB Data (ANG 189.00)
Additional Information
Notes
I agree to all terms and conditions related to KEP Membership (
Terms and Conditions
) *
