This form is for clients whose status is provisionally or permanently discontinued due to security concerns and policy violations. If your service has been halted and you have been directed to this form, then you may choose to make a complete submission of all of the requested information and documents. In some cases it will be possible for us to use a completed submission to inform a decision with respect to the account. If you choose not to submit a complete form there will be no review, and the service status will become permanent.

Submit information for review

If you have been directed to this form and you would like us to reconsider your status on our systems, please complete the form below and submit supporting information for each person and company connected to your account or accounts. We expect that you will make multiple submissions.

Please ensure that all unpaid accounts are paid in full before submitting information for review.

Please ensure that your submissions are complete and truthful. Do not omit any information without providing an explanation for each omitted item. Incomplete submissions will not be processed.

Information about yourself

Please provide your regular name and the contact email address under which your account is registered.

Your full name

Your e-mail address

Information about the service

Please provide information about the Afrihost service that you would like us to review.

Name of primary service

Please state what this service is used for. We want to know why it is that you operate this particular web site, connectivity service, server or facility. Your answer should state specific details about the content the service handles, who the users and communication partners are, and what kind of communications and processing are involved:

What do you use this service for?

Supporting information for contact

For each person of interest, submit all of the information below. In the case of a company, please provide the details of an officer of that company.

Whose identity does this documentation relate to

Primary contact person Technical contact person Debit order account holder Credit card account holder Company officer Company

Full, unabbreviated name

What is your relationship to this person / organisation

No relationship Self Family member Friend Supplier Vendor Employee Employer

Land line contact number

Physical address

Postal code for physical address

SARS tax number

Identity document

Photograph holding ID

Recent municipal or tax statement

Bank account statement showing payment transaction

If a payment from this account was unsuccessful, please provide the reason for this failure.

Information specific to companies

In the case that you are submitting supporting information for a company identity, e.g. the holder of a credit card you have offered for payment, please complete this section. Please provide information about the nature of the goods and services you trade in, and how this relates to the services you are using.

Nature of business

Company registration number

VAT registration number

Audited financial statements

Motivation

Please provide an explanation of how you have been using our services in the past, how you have represented yourself in the past, and how you have been providing payment in the past. If you intend to make changes to this, please explain what changes will be made, and when these changes will be made. If there are any explanatory notes with respect to the documentation you are uploading, please make those notes here. If no explanation is provided that addresses our concerns, then the submission will not be considered:

Motivating text explaining what has been going on.
Please explain all uncertainty with respect to identity, payment, terms of service, etc. Do not omit this explanation.

Human check

Once you have filled in all parts of this form, and submitted each document and picture requested click submit to upload these. Incomplete submissions are not processed.

Submit documentation and information

Once you have submitted all the documentation requested, and also provided a meaningful explanation for each item omitted, please allow time for our staff to consider the information provided. In the event that your submission causes a change in the account status, we will notify the contact person of the account.