Recharge Agreement Form

In continuation of Agreement Form I hereunder furnish particulars of my Credit Card, which may be used for payment recoveries under the said agreement. All conditions set out in the said agreement will apply to usage of this credit card. I also authorise Uniconnect SIM Pvt. Ltd. to take necessary debits and / or authorisations at any point of time. I confirm having received the call charges tariff statement for the various countries I am travelling to.

Name*

Card Type*

Card Number*

Expiry Date*

Select 1 2 3

Select 2001 2002 2003

CVV *

Credit Card Issuing Bank Name *

 I agree read and agree with above terms & conditions. AGREE & Authenticate Credit Card