4. Wy, (Pom /ncfoouv1) ‘SLIMOBITEL SRI LANKA TELECOM PLC Registration No: PQ7 (Tobe filed by StrMobite staf Account No cRNo. APPLICATION FOR NEW SERVICES 1 Customer Information 1.1 Customer type (0) Home (b)offce (©Retgous 12 Name'inful. (personal or Buiess nome as ppeorin the NIC/ posit or Bsns egitraton) ev/M[uts [ther 1.3 ate of bith 1.4 National deny Card / Passport / Business Ressration No Mn, ‘SLIMOBITEL (Mandotory to atech a copy of NIC Possport or Busines Registration Cer iiete, 0 propriate] 115 VAT registration number if avaiable) 116 Tax exemption reference number (availabe) cation Oni Noe: Business Copies of Busines ReglstatonCerifeate, Form 20, documentary prof tax exempted) shale represented with the application. 117 Permanent Principle areas 1.8 Contact deta ‘4. Name (Contact person) Designation Contact numbers Fixed Maki (This mobile number will be used to send bling information and other communications in futur) Service Information /™ on 2 Service installation address 22 Blling Adress with Postal code (i aifrenefrom 23obove) 2.3 you are already an StTMobitl customer; (0). Existing Telephone/Account number (©). Do youneed a separate billfor the new service? Yes, No 2.4 Your preferred biling mode [a ebill viaemai) (b)Printed bt (via Post) * bo you need to view your bill ia web (My ai) Yes [—] No Mode of Connection ult connections are required atthe same locaton, please enter the No.of connections reuled inthe opprepiate) 3a Voice (Telephone) Broadband Peo A) ibee Note Fora singe StTMobitl ire Connectivity, you con get (2 Voice & 03 PEO TV connections aes ‘tan adstiona cost Please consult on StTMobit! sales copper representaove or detals Package Details 4. Voice Package 4.4.1 my phone: (ou moy use Cordless, CL or any other wir line phone of your choice «Available at SLT Teleshops.) 4.4.2 Home 46 Voice Pal ~ (a). Voie Pal - Premium (b). Voice Pal-Basic (free Phone with icemet capably valble) 4.13 Home 4G - Standared Voice 4.14 SLT IDD ie enabled by default on Copper & SLTMabitel Fibre.00 you want ta deactvate 10D? Yes (ondotory toil No 4.15 For Home 46 Voice Pal customers, do you need 00? Yes {To be fled by the sales ofcer) ear Valued Customer, SLIMobitel hereby acknowledge your eequest with tha Correspondence. ACKNOWLEDGEMENT & ORDER ACCEPTANCE RECEIPT ks, Please use the reference number stated below for future Reference number AstLine 2nd ine Sales Person4.2 Broadband Package ufmore than one connection, pease enter the No. of connections reuied in the appropriate box) “Time Based Packages ‘Anytime Packages Untinted Broadband ret ‘59 = we ser m0 babe bel FweUmemtedso 80 ‘ie Pa on snyoess___ 4300 cant eta |) wesfamiyre 0 ffx 80 cummicdso Sno |) bromine 20 foytioe 280 Uniwtdrinato "Sao | Mesfontyase” 200 svte 390 Unimeesrams Sas |) wes eos 29 sysene 00 a | wes ro te fers 670 uname ne] | eee So imeem sy treme ea] |) wee Che 9 fovowen 6390) wrevaemes 30) | cette 09 soysreme amo saint fw cl Sonata S88 Wegner tocion 350 Aiewon 0 f 1 wget) fee re) | 4.2.1 Static IP Required? ves J set] nol] 4.22 ADSL Router Installation: (Please consul an LPMobitel soles representative for price details) ysurMobie! [] (stated ty Sermo onetime os wl ppt) Note: 1 for Double Play (Voice + Broadband) service, customer has to purchase Megaline router separately 4.23 “stgo" community WiFi feature with International data roaming facity wil be added fre of charge to your SLTMobitel acount please tick "No" if not required "Note plese vist stable for ute ifomate. wo] (Wlease select the package with "If multiple connections are requlted enter the No. of connections inthe ‘appropriate box) Co oO (al (ony for strobe Fore] [—] 4.3 PEO TV Package (0) PEO Titanium (PEO Siver Pus {o) other (i PEO Platioun (w) PEO siver 43.1 HO Package 5 Value Added Services 5.1 Required additonal VAS services, Please not that al SLTMobitel Voice customers willbe provided free VAS buncle. Refer worwaitmabitel.k for details) {2 Password cll barring (Secrete codel[_] C. Selective Call Rejection/Acceptance [—] D. Donot disturb service [—] F. Complete call anno response [—] G. Metering pulses/polarty reversals [~] H. Hunting [Ee oetai tt A callbackon busy E Secretary service [Abbreviated Dialing ~] J. Conference 5.2 Other Value Added Services 2) Hi wyteeute = (] a)steuconnect [=] d)MeterngP utes >] other (i) PEO Entertainment [wi PEO Famity ol oO (i) PeOGo = (wip€0 Unnatham =] Cc otter o oe Pose rmenter tate yr SROADBAN Fat 8 MYST oe see by tng [str bigal Services: Sef Register at MySLT App and Portal ‘Customer Agreement I/We do hereby declare and confirm thatthe information above , furnished by me/us are true and correct. We confirm that We have received, read and understood the "Terms and Conditions for the Provision of Telecommunicaton Services by Sri Lanka Telecom PAC {Sk}, which are also avalable on stTMobitel website wurst k We shall abide by the sa "Terms and Conditions forthe Provision of Telecommunication Series by Se Lanka Telecom AC’ as maybe reused modified and supplemented by SLTMobiel from sme to time and more ful stated/updated under the said SCT obit! website wwwsttmabitel Ik Signaturels) 1 “ x 3 common seal? Date ‘SLT Mobitel Acknowledgement SuiMabitl Acknowledges the offer bythe Customer and shall endure its besteffo to provide the services, such provisioning of the service shall construe the final acceptance on the part of SUTMobitel_and forthwith the agreement between SUTMobitel and the Customer shall come into force in which the “Terms & Conditions forthe provision of services by SCTMobite shall form an integral part. Signature of SLIMobitel authorized officer Date, For Office Use Only CustomerID rimarynumber [TTT TT ETT) secondary umber JP] LLL Ld Serial No eset ses [sts] ICCIO/IMSI Number