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PLACE of BIRTH
COUNTRY of BIRTH ---TurkeySyrian Arab RepublicArubaAfghanistanAngolaAnguillaÅland IslandsAlbaniaAndorraUnited Arab EmiratesArgentinaArmeniaAmerican SamoaAntarcticaFrench Southern TerritoriesAntigua and BarbudaAustraliaAustriaAzerbaijanBurundiBelgiumBeninBonaire, Sint Eustatius and SabaBurkina FasoBangladeshBulgariaBahrainBahamasBosnia and HerzegovinaSaint BarthélemyBelarusBelizeBermudaBolivia, Plurinational State ofBrazilBarbadosBrunei DarussalamBhutanBouvet IslandBotswanaCentral African RepublicCanadaCocos (Keeling) IslandsSwitzerlandChileChinaCôte d'IvoireCameroonCongo, the Democratic Republic of theCongoCook IslandsColombiaComorosCape VerdeCosta RicaCubaCuraçaoChristmas IslandCayman IslandsCyprusCzech RepublicGermanyDjiboutiDominicaDenmarkDominican RepublicAlgeriaEcuadorEgyptEritreaWestern SaharaSpainEstoniaEthiopiaFinlandFijiFalkland Islands (Malvinas)FranceFaroe IslandsMicronesia, Federated States ofGabonUnited KingdomGeorgiaGuernseyGhanaGibraltarGuineaGuadeloupeGambiaGuinea-BissauEquatorial GuineaGreeceGrenadaGreenlandGuatemalaFrench GuianaGuamGuyanaHong KongHeard Island and McDonald IslandsHondurasCroatiaHaitiHungaryIndonesiaIsle of ManIndiaBritish Indian Ocean TerritoryIrelandIran, Islamic Republic ofIraqIcelandIsraelItalyJamaicaJerseyJordanJapanKazakhstanKenyaKyrgyzstanCambodiaKiribatiSaint Kitts and NevisKorea, Republic ofKuwaitLao People's Democratic RepublicLebanonLiberiaLibyaSaint LuciaLiechtensteinSri LankaLesothoLithuaniaLuxembourgLatviaMacaoSaint Martin (French part)MoroccoMonacoMoldova, Republic ofMadagascarMaldivesMexicoMarshall IslandsMacedonia, the former Yugoslav Republic ofMaliMaltaMyanmarMontenegroMongoliaNorthern Mariana IslandsMozambiqueMauritaniaMontserratMartiniqueMauritiusMalawiMalaysiaMayotteNamibiaNew CaledoniaNigerNorfolk IslandNigeriaNicaraguaNiueNetherlandsNorwayNepalNauruNew ZealandOmanPakistanPanamaPitcairnPeruPhilippinesPalauPapua New GuineaPolandPuerto RicoKorea, Democratic People's Republic ofPortugalParaguayPalestine, State ofFrench PolynesiaQatarRéunionRomaniaRussian FederationRwandaSaudi ArabiaSudanSenegalSingaporeSouth Georgia and the South Sandwich IslandsSaint Helena, Ascension and Tristan da CunhaSvalbard and Jan MayenSolomon IslandsSierra LeoneEl SalvadorSan MarinoSomaliaSaint Pierre and MiquelonSerbiaSouth SudanSao Tome and PrincipeSurinameSlovakiaSloveniaSwedenSwazilandSint Maarten (Dutch part)SeychellesTurks and Caicos IslandsChadTogoThailandTajikistanTokelauTurkmenistanTimor-LesteTongaTrinidad and TobagoTunisiaTuvaluTaiwan, Province of ChinaTanzania, United Republic ofUgandaUkraineUnited States Minor Outlying IslandsUruguayUnited StatesUzbekistanHoly See (Vatican City State)Saint Vincent and the GrenadinesVenezuela, Bolivarian Republic ofVirgin Islands, BritishVirgin Islands, U.S.Viet NamVanuatuWallis and FutunaSamoaYemenSouth AfricaZambiaZimbabwe
(phone number, you will find this number on the package)
(ICCID, You will find this number on the back of your simcard and begins with 89)
NB: if you are a minor, the identification must be done by your legal guardian. The data entered in the form above will be subject to verification. e-LUX Mobile reserves the right to refuse the activation of your prepaid card if we deem that the data entered in the form are false, inaccurate, outdated or incomplete.
Please upload a copy of your ID. Your photo, the number of the document, and your personal details must be clear and legible. Files must be less than 2 MB. Allowed file types: jpg jpeg png pdf.
The only accepted documents as proof of identity are a valid identity card and/or a passport still valid on the day of signature of this form. The use of e-LUX service related to the prepaid card (s) as indicated in this form will be under sole and full responsibility of the identified person through this form. The identified person in this form will refrain specially from (i) selling, reselling, or exploiting to what purpose or any form whatsoever any of e-LUX service use, or any direct access to e-LUX and (ii) use e-LUX service in the violation of public order and morality and/or laws and regulations in force.
The personal data collected through this form by e-LUX Mobile Telecommunication Services S.A., in its responsible treatment quality, will be treated only to enable the pursuit of a legitimate aim and conserved as long as necessary. The data could be communicated to one of the e-LUX group society or to the subcontractors or third party within the purposes set out above or for the purpose of prevention, investigation and prosecution. The client disposes any moment a right of access, rectification and suppression of its data with personal character. In this last case, the service cannot be executed anymore. The request will be made in written directly by the client with the copy of his identity card. The data with personal character could be treated by e-LUX for promotion purposes by mail of the products or accessory or auxiliary services presents at the service, unless expressed opposition of the client to be addressed in written with the copy of the identification card to e-LUX. If this promotion is made by e-mail, each e-mail with the direct prospection purposes for the products or analogues services at the present service will inform the client of the opposition possibility without any charge to the exploitation of his electronic coordinates.
