Identification

Type of legal entity*

Type of ID or registration*

ID or registration number*

NWK Online password

Only if you are an existing account holder

Personal- and/or business information

Title

Surname

Initials

First name

Full name

Racial group

Gender

Date of birth

YYYYMMDD

Marital status

Spouse name

Spouse surname

Spouse ID number

Spouse date of birth

YYYYMMDD

Spouse contact number

Spouse gender

Business / Organisation name

Representative ID number

Representative name

Representative surname

Business registration date

Language

Contact information

1)

Telephone number

gdddd

2)

Telephone number

3)

Telephone number

4)

Telephone number

5)

Telephone number

1)

Cellphone number

gdddd

2)

Cellphone number

3)

Cellphone number

4)

Cellphone number

5)

Cellphone number

1)

Email*

gdddd

2)

Email

3)

Email

4)

Email

5)

Email

Street address/farm

Suburb

City

Postal code

Tick this box if you do not have a postal adress (same as physical address)

Postal number

Postal suburb

Postal city