Request for Extension

1 Start 2 Complete

Personal Information

Account Owner’s First Name *

Account Owner’s Last Name *

Contact Number *

Email Address *

Confirm Email Address *

ID Type *

Documents

Attach copy of ID for Account holder *

Files must be less than 4 MB.
Allowed file types: gif jpg jpeg png pdf.

Attach copy of ID for Authorized Representative

Files must be less than 4 MB.
Allowed file types: gif jpg jpeg png pdf.

Attach copy of Power of Attorney

Files must be less than 4 MB.
Allowed file types: gif jpg jpeg png.

Extension Form

Account/Main Phone Number *

Effective Date *

Month

Day

Year

Number of Extensions

Disclosure *

I hereby declare that the information provided in this application is true, complete and correct to the best of my knowledge and belief. I understand that in the event that if my information is found to be false or incorrect at any time, this shall result in the termination and disconnection of my service(s) with GTT. Where applicable, I do acknowledge the provision of false information may result in additional penalties pursuant to the laws of Cooperative Republic of Guyana.