Channel Partner Form UAE

Basic Details

First Name *

Last Name *

Email Address *

Mobile / Phone *

Company Details

Company Name *

Company Website

Trade / Company License No *

ORN Number *

BRN Number *

Number of Brokers *

Company Address

Office Number

Tower/ Building Name *

Street Name

Area *

City *

Country *

P.O. BOX NO.

Company Contact Details

Owner / Authorized Signatory Name *

Owner / Authorized Signatory Email Address *

Owner / Authorized Signatory Mobile No. *

Company / Admin Email Address *

Company / Admin Landline Number *

Company / Admin Mobile Number *

Accounts Email Address*

Company Bank Details

Bank Name *

Bank Account Name *

Account Number *

IBAN No. (UAE) *

Swift Code *

Bank Branch Address *

Currency *

Company Files (PDF, JPEG, PNG, DOCX)

Trade License *

Trade License Expiry Date *

ORN Certificate *

ORN Expiry Date *

Broker Card Copy *

Broker Card (BRN) Expiry Date *

Owner / Authorized Signatory Documents *

Owner / Authorized Signatory Doc Expiration *

MOA

TAX Certificate / Non-VAT Declaration *

Bank Account Certificate *

POA (Power of Attorney)