Nigeria Starlink Impact Connectivity Application

Company Name *

Address

Street Address

City

State

Country

Postal Code

Name of person requesting the service *

Email *

Installer name (If applicable)

Phone *

What unconnected.org plan are you interested in?

Location Coordinates (Lat,Long). Add one location per line *

Impact Description *

Company Tax Identification Number (TIN) *

CAC Registration Number *

Enter the amount of service lines you wish to purchase. Ensure you add coordinates to all requested service lines above. *

Upload your company registration document *

Required for KYC purposes as per local telecommunication regulation

I confirm I will use these connections for creating social impact such as connecting schools, medical centres, and community centres. These connections will not be used for residential purposes or for commercial use or resale. I understand my service line may be terminated if not used accordingly. I have read the terms and conditions

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