Level A: Lifeline & Pendant Installation fee: (inc 3 months monitoring) Monthly service fee: (+ Vat unless Vat Exempt)

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1 Dear Sir / Madam, Thank you for your recent enquiry to Fold s Lifeline service. The Lifeline provides its users with the peace of mind that help is available by pressing their pendant twenty-four hours a day, 365 days a year. Fold offers three main service levels to best meet your needs: Level A: Lifeline & Pendant Installation fee: (inc 3 months monitoring) Monthly service fee: () This is our most popular service package, where the client has the lifeline and pendant installed in their home. By pressing their pendant a call is placed through to our response centre, who will assess the situation and take the most appropriate action, whether that be calling a neighbour, relative or the emergency services. Level B: Lifeline, Pendant and two additional sensors Installation fee: (inc 3 months monitoring) Monthly service fee: () This package is designed to provide the client with increased reassurance, through monitoring for home safety risks: Taps left on, Risk of Fire, Cooker Left On, Intruders / Bogus Caller and falls. Our installer will assess the client s needs during the installation. Level C: Lifeline, Pendant, Bed Sensor, and two Level B sensors Installation fee: (inc 3 months monitoring) Monthly service fee: () Level C offers the clients carers peace of mind, through monitoring the key night time risk of wandering around their home. The bed sensor also raises an alert if the client does not return to bed after a specified time, eg. Has fallen and unable to raise an alert. Once you have decided which package you are interested in, please complete the attached paperwork, including cheque for the installation fee; and return it in the envelope provided. On its receipt Fold will telephone you to arrange an appointment for one of our installers to come out and fit your Lifeline package, we will aim to have the package installed within ten working days. If you require anymore assistance, please do not hesitate to contact Fold TeleCare on Please return your application pack to: Lifeline Referrals, TeleCare, Fold Housing Association, FREEPOST BEL 4018, Holywood, Co. Down, BT18 9BR Yours Faithfully, Fold TeleCare Administration

2 Fold TeleCare Service () Level A Installation Monthly Total Payment At Installation Lifeline Unit and Pendant Level B Lifeline Unit, Pendant and two additional sensors Level C Lifeline Unit, Pendant, two additional sensors & Bed Sensor Level E Lifeline Unit, Pendant, two additional sensors or Bed sensor & Exit Alert 90 One-off Payment Installation 135 One-off Payment Installation 180 One-off Payment Installation 270 One-off Payment Monthly Monthly Monthly Install Service x Total Total Payment At Installation Install Service x Total Total Payment At Installation Install Service x Total Total Payment At Installation Install Service x Total Please note 3 months monthly service charge is required in advance at Installation Visit

3 Dear Sir/Madam As a TeleCare responder we would like to thank you for agreeing to become a vital link to the service we provide to our client. As a contact we would advise you that you may be called at any time 24 hours a day should our client require help in an emergency. Therefore it is vital that we are notified of any changes to your contact details. If you should change telephone number etc, please call TeleCare on the Freephone number below. It is also advisable that you have access to the clients home should an emergency arise. This may mean that you hold a key to the property or have access to one. Please note any calls from the lifeline are voice recorded. If you have any questions, queries or concerns regarding the service please do not hesitate to contact us. Head Office Fold TeleCare Fold 3 Redburn Square Holywood, Co Down BT18 9HZ Telephone Regional Office TeleCare - Clones Unit 6 Clones Business Technology Park 98 Avenue Clones, Co Monaghan Telephone foldtelecareservicedesk@foldgroup.co.uk Web Yours Faithfully Fold TeleCare Administration

4 Dear Sir/Madam As a TeleCare responder we would like to thank you for agreeing to become a vital link to the service we provide to our client. As a contact we would advise you that you may be called at any time 24 hours a day should our client require help in an emergency. Therefore it is vital that we are notified of any changes to your contact details. If you should change telephone number etc, please call TeleCare on the Freephone number below. It is also advisable that you have access to the clients home should an emergency arise. This may mean that you hold a key to the property or have access to one. Please note any calls from the lifeline are voice recorded. If you have any questions, queries or concerns regarding the service please do not hesitate to contact us. Head Office Fold TeleCare Fold 3 Redburn Square Holywood, Co Down BT18 9HZ Telephone Regional Office TeleCare - Clones Unit 6 Clones Business Technology Park 98 Avenue Clones, Co Monaghan Telephone foldtelecareservicedesk@foldgroup.co.uk Web Yours Faithfully TeleCare Administration

5 TELEPHONY SUPPLIERS SUPPORT OF SOCIAL ALARM SYSTEMS We have discovered that some Telephony Suppliers may not guarantee to support Social Alarm systems. This may result in your social alarm not getting through to the 24/7 monitoring centre. If your Telephony Supplier is not British Telecom you must check that they do support social alarm systems. You should find this issue referred to in the Terms and Conditions of your Contract with them. If it is not referred to in the Terms and Conditions we recommend that you contact your Telephony Supplier to check. We cannot guarantee our social alarm system will always work with all telephone Supplier Networks. Your safety is our paramount concern. Fold TeleCare recommends that you test your Social Alarm system on a monthly basis, by pressing the pendant or the button on your social alarm unit. Declaration My Telephony Supplier is. I have received and understand the information about Telephony Suppliers. Service User Name Service User Address.. Service User Signature. Date. For Official Use Information on Telephony Supplier added to service user database Date

6 FOLD HOUSING ASSOCIATION TeleCare TITLE: Service Payment Plan & Service Agreement DOCUMENT NO: 3 Prepared by: KN Authorised by: KMcS Version No: 1.0 Issue Date: Page 1 of 2 Service Option (please tick) Level A : Installation 120 (inc 3 months monitoring) Monthly Level B :Installation 195 (inc 3 months monitoring) Monthly Level C : Installation 300 (inc 3 months monitoring) Monthly Payment Method: (please tick) Installation fee by Cheque or Postal Order and Monthly Direct Debit Form Yearly by Cheque or postal order Yearly Payment: If you opt to pay yearly, this is paid in advance so your initial payment will be your installation charge plus nine months service charge. EG: Level A first yearly payment will be 210 : 120 plus nine months service fee of 90 I accept the payment options laid out in this plan and agree to contact Fold TeleCare if I wish to change any details Customer Signature Date. / /.. For Official Use Only Client ID Number:.. Payment:

7 FOLD HOUSING ASSOCIATION TeleCare TITLE: Service Payment Plan & Service Agreement DOCUMENT NO: 3 Prepared by: KN Authorised by: KMcS Version No: 1.0 Issue Date: Page 2 of 2 ID No.. Between Fold and.. Of.. FOLD WILL: Assess and install alarm equipment to suit your needs and advise you how to use it. Will provide a 24hr response service every day of the year monitored by Fold s Monitoring centre. Following a call, and taking your wishes into account, will take appropriate action, such as contacting GP s Relatives, Emergency services or contacts as required. Undertake to contact you approximately on a 12 monthly basis or as required to test and check your equipment and personal details to ensure we maintain accurate information and review your service requirements. Make arrangements to respond to any maintenance problems and resolve them as set down with in our Code of Practice. Fold are not responsible for faults beyond our control such as with Telephone & Electricity Service. for the installation and service provision from the date of installation to date of termination as detailed in Payment Options Form TSO: 015. In the rare event of us needing to suspend or vary the service we will contact you prior to such action being taken. Occasionally we may have to make changes to this agreement to improve our service to you. We will notify you in advance of any changes Record all calls to the Telecare Centre. All data will be held and processed in accordance with the Data Protection Act A seven day cooling off period exists. Should you be dissatisfied with the service or equipment provided you may cancel the service without penalty within 7 calendar days from the date of installation. I AGREE TO Enter into a minimum three month service contract with Fold, excluding the seven day cooling off period Test the pendant on a monthly basis and inform Fold of any changes in my details or contacts held by them. Allow access to Fold Staff to service or uplift equipment. To take reasonable care of the equipment installed in my home as this remains the property of Fold Telecare. Agree to payments for provision of service as per the individual payment plan. Inform Fold of my intention to have the service terminated by pressing my emergency button or phoning ( NI or ROI ) To appoint. as my representative to safeguard my interests and act on my behalf (If applicable). Date / / Signed Date: /./ Signed.Fold Head Office Regional Office Fold Housing Association Fold TeleCare 3 Redburn Square Unit 6, Clones Business Technology Pk Holywood Co. Down BT18 9HZ 98 Avenue, Clones Co Monaghan PH: NI ROI foldtelecareservicedesk@foldgroup.co.uk

8 10.1 Eligibility declaration by a disabled person Please note there are penalties for making false declarations Customer If you are in any doubt as to whether you are eligible to receive goods or services zero-rated for VAT you should consult Notice 701/7 VAT reliefs for disabled people or contact our National Advice Service on before signing the declaration. I (full name)... of (address) declare that: I am chronically sick or have a disabling condition by reason of: (give full and specific description of your condition); and that I am receiving from Fold Housing Association, 3 Redburn Square, Holywood, County Down BT18 9HZ * the following goods which are being supplied to me for domestic or my personal use: (description of goods) * the following services to adapt goods to suit my condition: (description of services and goods) * the following services of installation, repair or maintenance of goods: (description of services and goods) * the following alterations to my private residence: (description of alteration) * the services of monitoring a personal alarm call system and I claim relief from value added tax.... (Signature)... (Date)

9 Supplier I (full name) Fold Housing Association of (address) 3 Redburn Square, Holywood, County Down BT18 9HZ am supplying to the person named above: * the following goods: (description of goods) * the following services of adapting goods: (description of services and goods) * the following services of installation, repair or maintenance of goods: (description of services and goods) * the following alterations to a private residence: (description of alteration) * the services of monitoring a personal alarm call system for the personal use of the disabled person.... (Signature)... (Date) *Delete words not applicable Note You should keep this declaration for production to your VAT officer. The production of this declaration does not automatically justify the zero-rating of the supply. You must ensure that the goods and services you are supplying qualify for zero-rating.