Member Registration Form

Contacts: Tel: (+258) 21498774 / 21498802 | Cell: (+258) 823005564 | Fax: (+258) 21498817
Email: info.amos@tvcabo.co.mz / adamov@cognis.co.mz

*Please fill out all fields clearly in legible handwriting.

Company Name

Legal Status

Company Address

Company Tax ID (NUIT)

Business License (PDF, JPG, PNG)

Representative Name

Nationality

Date of Birth

ID/Passport Number

Attach Copy (PDF, JPG, PNG)

Representative Email

Representative Phone

Declaration: I hereby declare under oath that I am familiar with and will comply with the statutes and operational rules of AMOS.

Place and Date

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