Thank you for choosing PLOT

PLD 3A REV 03/19

FOR RESIDENTIAL USE
CAF No: HA 62156522
Home
Start your journey with us and experience the strongest connections at home.

® We'd like to get to� '1tHA,, ...

Full Name ( First Name, Middle Name, Last Name)

Mother's Maiden Name ( First Name, Middle Name, Last Name)

Birthday (MM/DD;vvvvi ID Provided ID Number

Home/Installation Address Unit/House No. Street/Barangay City

Province Postal Code Nearest Landmark

@ Let's keep / #11.,, �. •• Your e mail

- below should be used when you enroll and log-in tomyHOME (wwwp/dtcomph) so you can easily manage your account on/me

Mobile Number Office Number Home Number Email Address

Note: For Gmail, please visit https://tinyurl.com/ycc4sd99 for

information on dots in email.

In case we can't reach you, who can we contact? (Full Name, Relationship, contact Number)

0 Should
By providing the information above, I certify that I have secured the permission of my secondary contact person to receive calls for installation activities, bill reminder, service repairs on my behalf
there be an update ,n my secondary contact person details, I can vIsIt PLOT website (https://my.pldthome.com) or call 171 hotline.

How would you like to receive your Bill? Would you like us to publish your Name and Number?
Bill Delivery Agreement
YOUR ACCOUNT WILL BE AUTOMATICALLY ENROLLED IN PAPERLESS BILLING AT
THE EMAIL ADDRESS YOU PROVIDED.
QYES
I acknowledge that PLOT shall send me my Bill three (3) calendar days I authorize PLOT to pubIish my name, address and telephone
after the Bill Date via electronic mail (email) through the email address number in the Directory Listing (White Pages) I warrant that the
I specified in this form PLOT is deemed to have validly sent the Bill, information I provided for publishing is accurate and up-to-date,
and the Bill shall be deemed received at the email address I provided and may be used to reach or access me.
PLOT I agree to hold PLOT free and harmless from any liability for my
failure to receive the Bill despite it being sent to my email address.

By agreeing to receive my Bill via email, I understand that I will no

0 I do not allow PLOT to publish my name, address and telephone
NO

number in the Directory listing (White Pages).

longer receive a printed copy of my Bill.

Q I want to receive a printed copy of my Bill for free.

00 Tell us about the p� '1lHA,,

Voice (Landline/Telephone) Service:
w�--
Data (Broadband/Internet) Service Lock-in Period: Value Added Services
Ourrepresentat,vewou/dglad/yf/1/thisoutforyou.

Q Voice only: 24 months

Data (Broadband/Internet) Service: Q DSL Plans: 24 months Device/Content Name MSF Lock-in Period warranty
Q FIBR Plans: 36 months

Speed: Volume Allowance:

Q Wireless Services: 24 months
Q Others:
Modem Fee+ Installation Fee Promo, if applicable:

@) For PLDT Home Use only

Account No. Agent Code Telephone No. Solicited By/Date so No/SRN No. Clarity ID Encoded By/Date

I hereby certify that all information given here had been verified true and correct.

PLDT Rep/Sales Agent /Signature over printed name)

CUSTOMER APPLICATION FORM

 PLDT HOME SWITCH OFFERS
SUBSCRIPTION CONTRACT
SWITCH OFFER PLANS INCLUSIONS

 Unli Plan 1299  50% off on the PLDT Home DSL Monthly Service Fee for 6 months of my subscription
 Unli Plan 1699  Free Installation
PLDT HOME DSL
 Unli Plan 2899  Free WiFi Modem
 FREE Unli Fam Calls to 5 Smart/TnT/Sun numbers

 Unli Plan 1299

 Unli Plan 1699  50% off on the PLDT Home Fibr Monthly Service Fee for 6 months of my subscription
 Unli Plan 1899  Free Installation
PLDT HOME FIBR
 Unli Plan 2899  Free WiFi Modem
 Whole Home 3099  FREE Unli Fam Calls to 5 Smart/TnT/Sun numbers

By signing below, I confirm that I have read and understood the Terms and Conditions for PLDT Home DSL & Fibr found at www.pldthome.com
as well as the following terms and conditions for PLDT Home DSL & Fibr Switch Offers (the “Offers”):
PLDT Home DSL & Fibr Switch Offers:
1. I understand that the PLDT Home DSL & Fibr Switch Offers (“the offers”) are only available to current subscribers of broadband
services of other telecommunications providers. These Additional Terms and Conditions merely supplement the Terms and Conditions
for the PLDT Home DSL & Fibr Service, unless otherwise provided in these Terms.
2. As a precondition for my availment of the offers, I am required to submit the following documents:
a. Signed Customer Information Sheet
b. One (1) valid government-issued ID
c. Signed PLDT Home DSL or Fibr Subscription Contract
d. Signed PLDT Switch Offer Subscription Contract
e. Current non-PLDT broadband bill
3. Provided that I comply with the requirements set forth in the immediately preceding paragraph, and subject to PLDT’s Standard Credit
policies and facility availability, the offers will entitle me to the following benefits:
For PLDT Home DSL Switch Subscribers For PLDT Home Fibr Switch Subscribers
 50% discount on my PLDT Home DSL Monthly Service Fee  50% discount on my PLDT Home Fibr Monthly Service Fee
for the first six (6) months of my new subscription for the first six (6) months of my new subscription
 Waived installation fees  Waived installation fees
 Free WiFi modem  Free WiFi modem
 Free unlimited fam calls to 5 Smart/TnT/Sun numbers  Free unlimited fam calls to 5 Smart/TnT/Sun numbers
In the event that I am unable to provide my current non-PLDT broadband bill, my application will go through the standard PLDT credit
evaluation process. I also understand that my discounted monthly service fee will take effect starting on the 4 th month of my PLDT
Home DSL or Fibr subscription.
4. Contract Term
a. The contract term for my PLDT Home DSL/Fibr subscription shall be a minimum of three (3) years from the date of service
activation (the “Minimum Term”), subject to my availment of special promos, which may have the effect of extending the
Minimum Term.
b. After the Minimum Term, my subscription will automatically be renewed for the same period, unless a written request for
termination of my subscription is submitted to PLDT prior to the end of the Minimum Term or any renewal thereof.
5. Downgrade/Pre-termination
a. Should I terminate my subscription prior to the end of the Minimum Term, I will be liable to pay three times my full regular
PLDT Home DSL/Fibr Monthly Service Fee.
b. Should I downgrade my subscription to a lower plan:
 If within contract term, I will be liable to pay three times my full regular PLDT Home DSL/Fibr monthly service fee
as well as the applicable downgrade fee.
 If outside contract term, I will be liable to pay the applicable downgrade fees.
6. Account Treatment
a. Should I miss 1 payment on my first 3 months of subscription, the Switch Offer discount on my monthly service fee will
automatically be forfeited and consequently the monthly service fee of my plan shall revert to the regular and full rate.
b. Should my PLDT Home DSL/Fibr subscription get disconnected due to non-payment while I am enjoying the Switch Offer
discount, I will no longer be able to enjoy the mentioned offers even after I am able to settle my outstanding balance and my
subscription is reconnected.
In addition to the foregoing terms, I understand that:
1. My availment of the Offers shall be subject to the availability of facilities. In the event that there are no available facilities in my area,
PLDT will not be in any way liable for its inability to install the services applied for.
2. These offers are not in any way an inducement for me to terminate my current subscriptions with other service providers. I understand
that should my decision to avail of the Offers result in the termination of existing subscriptions with other service providers, I will be
personally liable for the payment of any pre-termination fees that may be imposed by said service providers.
3. PLDT shall not be responsible for installing the necessary in-house wiring for the services included in the Offers. In the event that the
in-house wiring present at my home is currently being used by other service providers and there are no other circuits available, I
understand that I cannot hold PLDT liable for its inability to install the service/s availed of and that should I induce PLDT’s duly
authorized installer to disconnect the equipment currently installed in order that its service/s may be installed, I cannot hold PLDT
liable for any damages that may arise from the installation of the services.