PayCentral FICA Registration

PayCentral - FICA Registration

Complete the form below to register your details and allocate your card.

Cardholder Details

Cardholder Name

Surname

Mobile Number

ID Number

Date of Birth

PayCentral accepts a maximum of 20 characters for the email address.

Address Line 1

Address Line 2

Province

Authorised Dealer

Tracking Number

Maximum 16 characters.

Card Number

Account Number

ID Document

Click to upload.doc, .docx, .pdf or .png up to 5MB

Proof of Address

Click to upload.doc, .docx, .pdf or .png up to 5MB

Bank Statement / Supporting Document (optional)

Click to upload.doc, .docx, .pdf or .png up to 5MB

Selfie or Signature (optional)

Click to upload.png, .jpg or .pdf up to 5MB

I consent to PayCentral processing my personal information for the purposes of FICA verification and card allocation.