Form No. : gEg-NGO1/ Impactware Technology Solutions Pvt Ltd (goEgo) 'go=go {J info@sceaonetwork.com Apramey, Flat No. 103, S. No 106/9/23, Behind D-mart, Baner, Pune MH 471045 IN Ne win goegonetwork.com © GO @lgoegonetwork (+94) 7068 7 10101 ‘#staychargedup Charging Station Installation Form pate [Ty Pee eceniaese Adres pet Resienial —|commeral —ineition — Compary [_] oer Name of Premises Aderess cryntlage state Distt ro ema, Gin aLUek ae) Model Name i Model Name Quantity MRP Pens Partnership Fee Instlation and Commissioning Charge & Unitrate of Elect & geCONNECT Monthy Subserption Charges & ‘Annual Maintenance Charges & Model Namo Per Unit Markup Mote! Name Per Unit Marku ‘Customer (6) 9090 (16) sianerononotobanet oaraoesoaerion ne Peace) Document Type PAN Card Etscricity Bit [| Canceled Cheque Noo feikcuaast eka na We have received the folowing documents | pavcare [7] etsticyan [7] canctedcheave [7] noe We have received payment via cheque No____/NEFTIRTGS UTRNo, —___________ fram the customer towards aPartnershipfoe-Re_______________ Installation & Commissioning— Rs ‘¢. goCONNECT Monthly Subscription Charges- Rs ‘Annual Maintenance Charges — Rs For Impactware Technology Solutions Pvt Ltd (gogo) Name & Signature of Authorize PersonSpecific Terms & Conditions Installation wil be paid by Service Provider depending upon the feasblly of wring (should be max 10 meter between the source and EVCS}. ‘Any extra lenath of wiring, if quired, tobe paid for bythe customer. ‘Charging willbe done trough goMe app which is avaiable at OSi/Android Platform, ‘The base cost andthe profit share ofthe Customer, onthe Markup, fo be deposted on a monthly bassin the Customer's account for reconciliation wherever applicable ‘The Customer to provide EVCS space wih toe e2W or two e4W parking bays depending on the type of EVCS. Allocation of nearby space on the wall for branding, adverisements, product and & app usage instructions for EV users. Exclisive conract can be terminated or renewed by both partes in 3 months’ notice period, In case the customer requests early closure of contact, the customer shal be lable to pay Rs. 10,000'- to goEgo ‘Session fee collected by goEgo Is subject to revision as per the terms of goME app Service Provider resarves all the rights fo the EVCS. The unit can be replaced with an equally compatible unt or providing improved charging ‘experience to the users. |_________ have read and hereby accopt the Specife Terms & Conditions above an behalf of in my capacty as, ____________ | am authorised to sign this form on behalf of the said premises: For (Authorized porson of the Promise holder)