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Mobile number porting request

By signing this form, you authorise MaxiConnect to transfer your mobile number from your current operator. This request constitutes termination of the contract with your previous operator.

1 Your contact details

Title *

Last name *

First name *

Street and number *

Postal code *

City *

Email address *

2 Number to port

Number to transfer *

PrePaid number (for prepaid cards only)

Desired porting date *

Respect my current contract's end date

Immediate porting Early termination fees may apply depending on your current operator.

At a desired date

3 Confirmation & Signature

⚠ Important information

This authorisation constitutes termination of the mobile phone contract with your previous operator. Early porting may incur termination fees. Other linked services (internet, TV, etc.) require a separate termination.

Place *

Date *

Signatory's full name * (in capital letters)

Signature *

Sign here with your mouse or finger

I certify the accuracy of the above information and authorize MaxiConnect to carry out the porting of my number in accordance with the general terms and conditions.

The download generates the PDF without sending it — you can print it, sign it and return it to us.

Mobile number porting request

1 Your contact details

2 Number to port

3 Confirmation & Signature

Request sent!