Broadband-Only Application

Transcription

1 Broadband-Only Application NEU PCPlus Programme - Broadband Only Scheme NEU PC PLUS PROGRAMME The Broadband Only scheme, by the nfocomm Development Authority of Singapore (DA) offers subsidised broadband access to students from low income families. Eligibility Criteria What to Submit - Oniy Singapore Citizens whose household ncome does not Please ensure that you have completed and prepared the exceed S1800 or the per capita income (PC) $500 shall be following forms/documents for submission. eligible for the Broadband Only Scheme. - The Applicant's household must have a pc, but not subscribed to any broadband service at home. Each eligible household can only apply for one (1) broadband service regardless of the total number of school-qoinq Children. Where to Submit Compulsory forms documents Application form Photocopy of Student Pass/Matriculation Card belonging to the applicant (if applicable) Photocopy of Birth CertificateslNRCs of applicant and all household members (both sides) Relevant medical documents/doctor's verification of the applicant's disabled condition (if applicable) Deed of Undertaking and ndemnity for NEU PC Plus Programme Broadband Service - Please submit completed form to your school's General Office M1 or Singtel Application form or to DA's appointed lead agencies. Supporting documents (compulsory if you are not TE students should submit application forms directly to the receiving assistance under MOE-FAS) Campus Administration Office. - Special Education (SPED) school students can submit application forms to the Society for Physically Disabled (SPD). _ Latest ncome Tax Assessment form or pay slips or CPF Contribution History for all working adults (including selfemployed) in the household. Working adults who do not have fixed monthly salary must produce the pay slips of the last 3 months or CPFcontribution history; and - Applicants who do not fall within any of the listed lead - Latest CPF Contribution History of all non-working adults in agencies, can submit to the Eurasian Association. the household DA's Appointed Lead Agencies Association of Muslim Professionals AMP(a'Pasir Ris # Pasir Ris Drive 4 Singapore Tel: Fax: wy'j~,ijltl...j2 org,~ Chinese Development Assistance Council CDAC Building 65 Tanjong Katong Road Singapore Tel:6603 5S88 Fax: WWW,Q;J9~&r:9..:.ill Society for the Physically Disabled 2 PengNguan Street SPD Ability Centre Singapore 1689S5 Tel: Fax: \V_\'V-'!JJ9C;~D!r~,Q!:g2g The Eurasian Association 139Ceylon Road Eurasian Community House Singapore Tel:64471S78 Fax; \'V'!:J\'V..~l!rasLaJ)s.Q~g Central Sikh Gurdwara Board 9 Jalan Bukit Merah Singapore Tel: /05/07 Fax: wy'jw.si1sb~.q-lll Sl nstitute Of Technical Education 10Dover Drive Singapore Tel: Fax: vvww.l1e.equ,sg Singapore ndian Development Association 1 Beatty Road Singapore Tel: / Fax; '!:Lww.sir]qa,Q.r~..g Yayasan MENDAK Wisma Mendaki NO,l Lorong 6 Toa Payoh Singapore Tel: Fax: wv:ly:j.,m~.9_itsiqr_g,~.g Version 3.1 (Apr 2012) Page 1 of 5

2 Approval and Notification The decision made on each case is final. For the avoidance of doubt, DA or the lead agencies need not provide any reason for the rejection of any application. Any change in the Applicant's home address and/or contact numbers before the broadband service activation should be reported to the Lead Agency handling the application. The lead agencies will inform applicants of the outcome by post. The broadband service provider will inform Applicant of the outcome of the application and arrange the date of delivery or collection of broadband device with the-applicant:..., DA and the Lead Agency shall not be held responsible for any cost, damages or expenses incurred by the Applicant due. to nondelivery or late or incomplete delivery of Broadband device. Co-payment The Applicant and/or the Applicant's parent/guardian shall make co-payment for the broadband subscription to the broadband provider, Subscription fee for unlimited broadband access is $1.50/month for 36 months, including broadband device and internet filtering service. Other information DA's appointed lead agencies reserve the right to ask for additional documents to support your application. DA reserves the right to amend the above terms & conditions as and when it deems necessary. The use of the broadband service is subject to such terms and conditions as may be imposed by SingTeiPte Ltd and Ml Pte Ltd and accepted by DA. Broadband Selection Guide ADSL 6roadband. Mobile Broadband Must have SingTel DELline as ADSL (Asymmetric Digital Subscriber Line) Broadband makes use of telephone line to give you dedicated broadband connectivity for a lag-free connection. Mobile Broadband gives you nternet access in Singapore where 3G coverage is available. Version 3.1 (April 2012) Page2 of 5

3 ">~""-' ~_._---...~-- Broadband Only Application Form PCR: LA receipt date: For official use only: NEU PC Pl.US PROGRAMME Applicant's Particulars NRC / Birth Cert No.: Name: Citizenship: Gender: Date of birth: (dd/mm/yyyy) School: Class: Home Phone: Mobile phone: Address: ----._-_._ Singaporean Male 0 Female Type of housing: 0 1-2Rm 0 3Rm 0 4Rm 0 SRm o Owned o Rented (Please provide rental proof) o Others: -_.. _ Broadband Options Please select the broadband mode you are applying for: o ADSL- Singtel o Mobile- Ml nternet Filtering Service allows parents to protect the child against access to undesirable websltes, images and content while surfing the internet. Do you wish to apply for nternet Filtering Service? o Yes o No Disability Particulars (if applicable) Are you receiving assistance under MOE financial assistance scheme? o Yes (Please obtain your school's officer-in- 0 No charge/hod/principal to complete the section on Pg 4) Permanent Disability: 0 Yes o No f yes, describe disability: ---- Household Members nformation. Name ~ - --_._-----, NRC Relationship Occupation School Gross Monthly ncome --,--- - e--. -~ '.._. ~--~ - - Household Financial nformation.-._---- syour household receiving financial assistance or maintenance allowance from any organisation / person? o Yes, please provide details below 0 No l ----, ---- Name of organisation person Address _ Contact No Amount received per month c----- Version 3.1 (April 2012) Page 3 of 5

4 Declaration by Applicant and Parent Guardian - We hereby declare that the information supplied is true and correct and that we have not willfully suppressed any material fact. f we have suppressed any material facts or provided any false or inaccurate lnformatlon, our application wilj. be r,.ejected and/or the broadband service withdrawn from us.., ~i.,... ':,«- We agree to comply with all the terms and conditions ofthe NEU PC Plus Programme..'. ~i - We understand that our application may be rejected by DA and/or the lead agencies without assigning any reason for doing so. - We acknowledge that, for the purpose of facilitating our application by DA, any and all government agencies or statutory boards that have any of our household's record may share the information with DA, if it is relevant to DA's work with us and/or our household. - We also acknowledge that the information which we and/or the members of our household provide may be shared with any government agency, statutory board or person authorised by DA, for the purposes of rendering us or assessing our eligibility for financial or other assistance; for research in which our household members, as specific individuals, shall not be identified; or for any other purposes prescribed or permitted under Singapore Law. We also hereby confirm that our household members are aware of and have agreed to these terms. Name and signature of Parent / Guardian# #Delete where appropriate Name and signature of Applicant Application submission date FOR SCHOOL USE ONLY Certification for Student Receiving Assistance under MOE-FAS only certify that the student is a Singapore Citizen receiving assistance under MOE Financial Assistance Scheme. Name and Signature of Officer-in-charge/HOD/Principal# School stamp Date #Delete where appropriate Version 3.1 (April 2012) Page 4 of 5

5 Deed of Undertaking and ndemnity for NEU PC Plus Programme Broadband Service THS DEEDS GVEN BY: The person whose name, NRC, address and signature appear in the table below labelled' APPLCANT' ("the Applicant"), TO: THE NFO COMMUNCATONS DEVELOPMENT AUTHORTY OF SNGAPORE, a statutory body constituted under the nfo communications Development Authority of Singapore Act (Chapter 137A of the Statutes of the Republic of Singapore) ("DA"), THE APPLCANT HEREBY RREVOCABLY AND UNCONDTONALLY UNDERTAKES AND AGREES AS FOLLOWS:, Definitions n this Deed, the following capitalised words and expressions carry the following meanings: "Broadband Service" means the broadband service provided to the Applicant under the NEU PC PlusProgramme, "Deed" means this Deed of Undertaking and ndemnity, "Third Party User" means any individual or organisation, other than the Applicant and DA, that usesthe Broadband Service, 2 Applicant's Responsibilities and Obligations ' a, The Applicant is solely responsible for any use of the Broadband Service, regardless of whether the Broadband Service is used by the Appllc?nt or by any Third Party User, The Applicant will be responsible for the use of the Broadband Service by a Third Party User whether or not the Applicant has given permission to the Third Party Userto use the Broadband Service, b. The Applicant shall ensure that all use of the Broadband Service, whether by the Applicant or any Third Party User, complies with applicable laws of Singapore and/or any other relevant jurisdiction, c. The Applicant shall indemnify and keep DA indemrufied aqainst. and hold DA harmless from, any and all loss,damage, claim or expense (including legal expenses)arising from or relating to any of the following: i. Any use by the Applicant or a Third Party Userof the Broadband Service for any purpose, ii. Any failure by the Applicant to perform or observe any term or condition of any of the following documents: (a) This Deed (b) Any document between the Applicant and DA or the Broadband Service provider that relates to the provision or use of the Broadband Service, iii. Any interruption, downtime, fault, or loss of use of the Broadband Service, iv. Any termination of the Broadband Service, 3 DA Disclaimers and Exclusions of Liability a, DA will not be liable to the Applicant or any Third Party User,under any circumstances for any type of loss or damage whatsoever, including loss of profit, savings, business, contracts or revenues, and all other forms of actual, direct. special, incidental or consequential loss or damage, relating to or arising out of any of items listed in paragraphs 2,c.to 2,eiv above, even if DA knew, or should have known, of the possibility of such loss or damage, b. The Broadband Service and any related technology, software, hardware components and data are provided "as is" and "with all faults' and there are no warranties, express or implied, by operation of law or otherwise, made by DA with respect thereto, To the maximum extent permitted by law, DA expressly disclaims all implied warranties, terms or conditions of satisfactory quality, merchantability, fitness for a particular purpose, title or noninfringement, and any implied warranties arislnq out of course of performance, course of dealinq or usage of trade, relating to the Broadband Service, 4 Termination for mproper Use of Broadband Service or Breach of Applicant's Obligations ida may, at its absolute discretion and without providing any reason, terminate the Broadband Service at any time without informing the Applicant beforehand, if any of the following occur: a. DA has any reason to suspect or believe that the Broadband Service has been used by the Applicant or any Third Party User 111 any illegal, unethical, immoral, improper or suspect manner, b. The Applicant fails to perform or observe any term or condition in any of the documents listed in paragraph 2.cii above, 5 Premature Termination of Broadband 5ervice n the event the Broadband Service is terminated for any reason whatsoever within 36 calendar months of its commencement, DA reservesthe right to require the Applicant to bear any and all charges in respect of the Broadband Servicefor the period between the date of termination and the expiry of 36 calendar months from the commencement of the Broadband Service, 6 Governing Law This Deed is governed by and is to be construed in accordance with the laws of the Republic of Singapore, Deed of Undertaking and ndemnity for NEU PC Plus Programme Broadband Service SGNED. SEALED and delivered as a Deed ----, ' Consent of Parent/Legal Guardian* [ A_P_P,L1CA_N_T , the undersigned, parent/legal guardian" of the above minor Name: Applicant, have reviewed the terms of this Deed and hereby consent to NRC: the above Applicant's execution of this Deed and agree for the Applicant to be bound by the terms of this Deed. Address: Signature: Date: --' Name and Signature: Relationship to applicant: "Required if the Applicant is below eighteen (18) years of age "Delete the inapplicable ---"- N THE PRESEN"CE OF WTNESS - ~ ~ho must be at least 18 years_~ld, and who must not be the parent/legal guardian consenting to the Applicant's execution of t~\s Deed) Name: -r NRC: l Signature: ----_._-----, _---- ~~~:. --'-td~t~~-...l_. _ Version 3,1 (April 2012) PageSofS

6 Ml-DA Mobile Broadband Service Application Form (10 be completed and signed by Parent/Guardian f applicant S below 18 years.of age) PCR Number: Applicant's Full Name & NRC:...._._. (below18vrs Old) Applicant (18 Years Old & Above) Parent / Guardian Details Name in NRC / Passport / FN of Applicant (18 Vrs Old & above) OR Parent / Guardian Gender Fp.male Mal,. (*Mr/Miss/Mrs/Mdm/Ms) Marital Status: Single Married NRC/ FN of Applicant / Parent / Passport Number Date of Birth (DD/MM/Vy) Nationality Guardian Local Billing Address Residential Address Contact No (Home) : Contact No (Office): (Mobile): Mobile Broadband Plan and nternet Filtering Service ( ):,. Broadband 1Mbps.J Broadband 2Mbps (Apphlanl pays $0.00 under PC-Bundle Scheme) (Applcant pav~ $6 S2ilTlomh under PC-BundleScheme) \Appllcant l1.jys S1.,o!rnonth under BO'Only Scheme) (Apphlant pays $8.o2!month under Bb-Onlv Scheme) Service Commitment Contract 1. Customer must subscribe to M,'S Mobile Broadband Mbps! 2 Mbps for a contractual period of 36 months ("Commitment Period"), n the event that customer prematurely terminates M Mobile Broadband services before expiry of the Commitment Pel iod, the customer shall pay Ml the applicable early termination charge: Tenure Earlv Termination Charge- -~_.. For Tenure of 0 to less than 12 months $107,00 For Tenure of 12 to less than 21 months $64,20 For Tenure of 24 to less than,6 months $,2,10 2, Customer who defaults on payment of his bill and is terminated by Ml during the Commitment Period shall also pay to Ml the amount a; stated in Clause 1 herein, 3 f the- customer's SM card is lost or stolen before- the expiry of the Commitment Period, customer must either: _ a) Buya new SM card and continue with the subscription for the full Commitment Period; or b) Terminate prematurely and pay M, the amount as stated in Clause 1 herein, 4, Customer is not allowed to temporarily disconnect M1'S services before the expiry of the Commitment Period, " Customer is not allowed to transfer this Mlline. 6, f the customer changes service plan from Mobile Broadband 1 Mbpo to Mobile Broadband 2 Mbps, the difference in monthly subscription payable will be borne by the Customer, and not funded by the nfocomm Development Authority of Singapore (DA), 7 Customer is not allowed to change bill plan to a service plan other than Mobile Broadband Mbps! 2 Mbps during the Commitment Period, 8, nternet Filtering service is for a fixed subscription on 36 months, Premature termination of nternet Filtering service without terminating the mobile broadband line is not allowed. n the event that customer prematurely terminates the Filtering service, customer shall pay M on a pro-rated basis for the remaining months of the 36 months Commitment Period based on the rate of $,.28 per month. 9, M,'s General and Specific Terms and Conditions for the provision of services at also apply to this contract. n cases of inconsistencies, Clauses 1 through 8 herein shall prevail. For Official Use Signature of Applicant i Parent Guardian Date of Purchase Mobile Phone No,! LON Mobile Phone Model Remarks SM Card No. (For GSM network) (please paste sticker here) Equipment No. (ME) (pleas. paste sticker here) Attended by: Signature' Name of Staff / Date

7 ---~ _.'--~- SN. [ per N umber : SingNel Broadlsund Access Service Applicanonrum.vgreernent Form ",fil.''\i,,>! \'te i id Company re~ no 'JOW YOUR PARTCULARS Dale of Birth (dd'mmyi) Residential Addrt:.;5s: {Ql......_. {HP,'PGl '..... _ f'iea'~ fill in p:lrh.:uldr-, ot pdre'nl.'.d~\.ldi;:n ~'r author!...ej ltlll'er fnr applicant he-h\.\ ;{ :Y~~lr~ uij ;,\, ",liss:md",:d" NRCFNPassoorl No. r ;~lepi'lone (H) _.._..,_..(0: Tel fadsl Actlvutton Tel (ADSL) No. lor SingNel BroadBand aclivallon:. Name and NRC/FN No. ot Subscriber of the Tel (ADSL) No._ No. of Parallel Tel. Exr: 1 main + ( _",,. _J extensions Singl"et BroadBand Package: o Option 1 Sing Net BroadBand' Mbps Unlimited Plan + PC Bundle (36 months contractual period) o Sing Net Security Suite (optional) o Option 2 SingNet BroadBand 1Mbps Unlimited Plan $1.50 per month (36 months contractual period) o SingNet Security Suite (optional) Sinl(:'oet BroadBand Terms & Conditions 1. The subscription service provroeo by SingNet is structured as a package under NEU PC PLUS. This broadband package is only available under this program. 2. This is a 1Mbps Un,mited Plan and has a 36 months contractual term commencing from the dale of the service activation. 3 The service is bundled with a free ADSL Ethernet modem which is non-refundable. returnable or exchangeable. 4. Your residence must be pre-equipped with a SingTe! fixed telephone line. 5 t the fixed lelephone line is not registered in your name (eg the telephone line is registered under your parent's name). you musl warrant that you have obtained proper authorization from the registered customer of the telephone line to enable it for SingNet BroadBand. f the consent by the registered customer S Wthdrawn for any reason, the broadband service will be terminated and you will have 10pay all charges incurred. including early termination charges.. 6. For Security Suite service. an will be sent 10subscriber's SingNet account to instruct subscriber to download the SingNel Security SUte, powered by McAfee. SingNel Security Suite can be downloaded and installed up to 3 computers.. 7. Each SingNet BroadBand account is valid for a single user, who applies with a residential line. to login to a single connection session. and not for multiple concurrent logins. f mulliple concurrent logins are detected, an additional fee may be imposed on the applicant for each multiple session logm at prevalhng monlhly subscription rates.. 8 Applicants currently using a VPN (virtual private networx) may need to pcrchese a Win PoET or MacPoET dialer from SingNet authorized installers or modem vendors. 9. f the applicant Changes addresses rom the original installation site. a re-acnvauon charge will have to be borne by the applicanl. 10. This service is subject to the premature termination charges Applicanl has to pay the premature termination charges for any premature termination at the rate of 80% 01the monthly recurrtnq charges tor the period between the date 01termination and the expiry of the contract term. 11 Prices are inclusive of prevaiing OST. 12. SingNel's Broadband Terms and Conditions of Service shall appiy to the service(s)/product(s) subscribed. For details, please refer to SingNet BroadBand website. Ur-oOERTAKNG :t.1\"~ confirm thai all informauon glvt!'1l by *me/us in connection with this application i~ true and correct. '/We agree to subscribe for SingNel's BroadBand Access Service on the lollowing terms and conditions, which terms and conditions shall apply on SingNel's acceptance ot this application including any amendments SingNet or SingTel (as applicabie) may make lrom time to time to those terms and conditions. Signature of ; APPiicar;'t1AlXhoriSedP-e-rso-~ Dale \\llt" f111~ n:t~'" 111 [he!i ved line 11l~.lkJ! ~\\lr hl1llh:.1f 1t't'phnllt" ctlh \ 1,1 Slll~rt'l Thi.,1...'1"1'\ n lilt' numrcr llll'h'lllc' lmc- ~llnll ~ L,llll ~ 1\~11 main L'lL'phllllt! 1l111l1x"1 ~\ horuecurrently Page 1