01 TELSTRA MOBILE BROADBAND ( TMB ) SERVICE DETAILS

Transcription

1 TELSTRA NEXT G MOBILE BROADBAND NETWORK SHARED PLANS APPLICATION FORM 01 TELSTRA MOBILE BROADBAND ( TMB ) SERVICE DETAILS TMB service number : : : : : : : : : 02 ACCOUNT HOLDER DETAILS Account name/account holder Title Surname Given name Choose one TMB shared plan: Shared Plan Monthly Casual Shared plan (do not include subsidised TMB device) $59.95 $74.95 $ Month Standard Shared plan (include partially or fully subsidised TMB device) $44.95 $54.95 $94.95 Amount payable by you upfront (applied to your first Telstra bill) for TMB device (if applicable) Trading name (if applicable) Account holder address ACN/ABN/ARBN $ 24 Month Member (SIM Only) Shared Plan (do not include subsidised TMB Device) $9.95 $49.95 $89.95 TMB shared plan end date / / USIM serial number TMB Modem/Mobile Wi-Fi/Tablet/Wireless Gateway/Embedded Laptop (if purchased): Manufacturer/brand Model IMEI Period at current address Phone number Fax number Years Months Is the phone number silent Yes No Previous address (if less than 12 months at present address) Period at previous address Phone number Fax number Years Months Billing address (if different to account holder address) address Years of incorporation (companies only) Industry type (if applicable)

2 0 ADDITIONAL DETAILS FOR ACCOUNT HOLDER a) Other Telstra services in account holder name (b) Personal, Sole Trader, Partnership and Unincorporated Accounts only Main purpose of Service Business Residential Status Personal Renting Owner/Buyer Living with Parents Boarder Overseas Visitor Other (if applicable) Occupation Employer s Phone Number Employer Length of Employment Years Months b) Personal identification Enter details in relevant fields (eg, do not enter credit card number if used) Date of birth / / Primary (at least one form) Secondary (at least one form) Total points (must be 100 minimum) DOCUMENT TYPE POINTS DOC/ACC.NO. DATE ISSUED EXPIRY DATE 04 USER DETAILS (IF DIFFERENT FROM ACCOUNT HOLDER DETAILS IN 2) Title Surname Given name 05 COMPANIES, INCORPORATED ASSOCIATIONS & GOVERNMENT DEPARTMENTS (IF THE APPLICANT IS NOT AN INDIVIDUAL) Verified ID of representative (eg employee card, corporate credit card) Type of ID Full name Letter of authorisation or Purchase order no. Directors, committee members or authorised government representatives (if different from account holder details) Surname Given name Phone number Exipry date / / 06 MOBILE REPAYMENT OPTION (APPROVED MONTHLY CASUAL AND MEMBER PLAN CUSTOMERS ONLY) Customers must ensure that the Mobile Repayment Amount selected is equal to or less than the TMB device (incl. GST). TMB device (incl. GST): $ Mobile Repayment Amount selected (credit): $ Amount payable by you upfront to the dealer or Telstra store $ (difference between the TMB device and the Mobile Repayment Amount incl. GST) Mobile Repayment Option Term: 12 mths 24 mths Other (if available) I agree to pay the monthly repayment amount (Mobile Repayment Amount divided by months in Mobile Repayment Option Term) of $ * for * months to Telstra, in return for Telstra paying the Mobile Repayment Amount to the Dealer or Telstra store on my behalf to contribute to the upfront cost of a TMB device (and/or any eligible mobile accessories). * Final monthly repayment may be higher to cover total Mobile Repayment Amount.

3 07 DEALER AUTHORISATION I am satisfied that the details provided on this form apply to the Account Holder and that the Account Holder/Authorised Signatory has shown me 100 points of current identification (in original form) to meet Telstra s ID requirements. I confirm that I have provided a copy of the Business Important Information Your Rights and Obligations Booklet ( Booklet ), and the relevant My Offer Summary to the Authorised Signatory/Account Holder. If this application relates to connection of a 24 month Shared Plan which includes a subsidised TMB device, I nominate the equipment described above for participation in the promotional package. Dealer/Agent Premise code : : : All information you have provided in this application is correct. You may be able to use your Telstra mobile services to purchase goods, services or content from a third party. If you do so, Telstra will debit the charges for the content, goods or services from your account. If you don t pay Telstra when due, Telstra may cancel your service. Your TMB device is programmed to operate on the Telstra Next G network. An unlocking fee of $27.50 will apply if you wish to use your device on another network. That Next G coverage depends on your location, the device and if it has an external antenna. Coverage information on the Telstra Next G Mobile Broadband network is available from telstra.com (telstra.com/mobilebbcoverage). NAC operator Authorisation no. Name of dealer/agent representative (please print) Signature of dealer/agent representative Date / / 09 ACCOUNT HOLDER ACCEPTANCE I warrant that all information in this application is correct. If I am not the Account Holder, I warrant that I am authorised to sign this form on behalf of the Account Holder. Account holder full name (please print) Date / / 08 IMPORTANT TERMS TO BE READ BY ALL APPLICANTS Important: Please read these terms, the terms on the back of this form, the My Offer Summary we give you and the Booklet. If there is anything you don t understand, please speak to the dealer or us. By signing this form, you are acknowledging that you have read and agree to be bound by the terms in this form, as well as Our Customer Terms. You agree: You are responsible for any use of your Telstra service, whether you authorise it or not. Under Our Customer Terms, we can change the terms and prices of your plan. The summary of Our Customer Terms sets out how we can do this. If you use your Telstra service overseas, you will be charged for international roaming. If you use mobile data services overseas, it won t come out of your included data, and unless you take up a separate plan, you will be charged $15.6 per MB. We have explained to you that you will be charged for data you use in excess of, or which is not eligible to draw from, the included data on your plan. Our Customer Terms sets out the type of use which is not eligible. We have tools you can use to monitor your data usage and we recommend you sign up for these. You have received the Booklet which includes a copy of Telstra s Privacy Statement Protecting Your Privacy. Important Do not sign this application unless you have received and read the Booklet and the My Offer Summary. Only sign this section if you wish to proceed with your application. Account Holder/Authorised Signatory Mobile devices may interfere with sensitive biomedical electronic devices check with your specialist before use.

4 TELSTRA NEXT G MOBILE BROADBAND NETWORK SHARED PLANS TERMS AND CONDITIONS 01. Eligibility The included data allowance available on Telstra Mobile Broadband ( TMB ) Shared Plans ( Shared Plans ) may only be shared between other users on the same account who have at least one of the following Telstra services: Telstra Business Mobile Advantage Plan, Telstra Mobile Broadband Shared Plans, Telstra Embedded Shared Plans. Telstra Mobile Broadband Shared Data Plans connected prior to 2 August 2011 are not compatible with Shared Plans. You must have a 10 digit account number and an ABN, ACN or ARBN. 02. Shared plans You can access the TMB service with the following Shared Plans ( Eligible Shared Plans ): a) 24 month Standard Shared Plans ( Standard Shared Plans ); b) 24 month Member (SIM Only) Shared Plans ( Member Shared Plans ); and c) Monthly Casual Shared Plans ( Casual Shared Plans ). 0. Your payment obligations You will need to pay us: a) the monthly service/access fee for your selected Eligible Shared Plan; b) any usage fees and charges as set out in Our Customer Terms (for example, any data charges above your monthly included kilobytes and any charges for your mobile voice plan); and c) any applicable early termination charge ( ETC ) as set out below. If you have an Eligible Shared Plan and are eligible for an account level discount, the discount will only apply to data usage in excess of your monthly included data allowance. If you use more than your monthly included kilobytes, you ll be charged an additional amount per MB (as set out in Our Customer Terms), up to a maximum of $500 ( Excess Cap ) or as set out in Our Customer Terms. We can charge you outside the Excess Cap for the monthly service fee and data used in international roaming. 04. Changes to plans You may move to another available Eligible Shared Plan at any time. If you do so, your monthly service fee, usage and call rates and included monthly kilobyte allowance will be adjusted on a pro-rata basis to reflect your new eligible shared plan. You will receive the full amount of the shared data allowance for the new Eligible Shared Plan irrespective of the timing of the current billing cycle at the time the new Eligible Shared Plan is connected. If you re on an Eligible Shared Plan: a) for a 24 month term and you move to a higher value plan, your existing 24 month term will continue and you can move back to your original lower value plan without incurring an ETC; b) which is a Standard Shared Plan with a 24 month term and you move to a lower value plan, you ll need to pay an ETC and recontract with another subsidised TMB device on a new 24 month term; c) which is a Member Shared Plan with a 24 month term and you move to a lower value plan, you ll need to pay a $50 administration fee and recontract on a new 24 month term; d) for a 24 month term and you move to a casual plan on a month to month basis, you ll have to pay an ETC; or e) for a 24 month term and you make more than one change to your plan in a two month period, we can charge you a $50 administration fee. 05. Early Termination Charges You may terminate your plan, or move to another plan at any time. However, if you terminate your plan during your minimum term (other than for a material breach by us) or if we deactivate your plan during your minimum term for a material breach by you, we may charge you an ETC, calculated as follows: Base ETC amount for your selected plan x Number of months (or part thereof) remaining in your 24 month term The Base ETC amount for each Standard Shared Plan varies depending on the device you have taken with that plan. The Maximum ETC amounts for Standard Shared Plan (GST Inclusive) are as follows: $44.95 = $1,078.80; $54.95 = $1,18.80; $94.95 = $2, The Base ETC amounts for Member Shared Plan are as follows $9.95 = $479; $49.95 = $549; $89.95 = $ The ETCs specified here relate only to these plans. You may have to pay an additional ETC if you also cancel your mobile voice plan. 06. Mobile Repayment Option ( MRO ) If you don t repay the MRO amount when due, we can suspend or terminate your TMB service or account or your mobile voice plan in accordance with the General Terms of Our Customer Terms. If, for any reason, you re no longer connected to the plan that your MRO relates to, you will need to repay the outstanding MRO and any other amounts you owe us, before the end of your MRO term. 07. Privacy considerations Please read Telstra s Protecting Your Privacy statement in the Booklet carefully. It summarises how Telstra, its related companies and its dealers will collect, use and disclose your personal information (including for marketing to you) and your rights in accessing and collecting that information. The Privacy Statement is also available at telstra.com.au/privacy/privacy_ statement.html. By submitting this application, you confirm that we may, subject to the Privacy Act 1988 (Cth): a) disclose information about you and your application (including information contained in any application for additional services and information relating to the conduct of your account) to a credit reporting agency for the purpose of obtaining and maintaining a credit information file about you, and to another credit provider or collection agent for the purpose of collecting overdue payments relating to credit owed by you and notifying defaults by you; and b) obtain and use information about your creditworthiness (including a consumer or commercial credit report) from a credit reporting agency, credit provider or other business that reports on creditworthiness for the purpose of assessing an application (including the application and any application for additional services) or collecting overdue payments. In this section, you and your refers to you and your Account Holder/ Authorised Signatory (if applicable). 08. GST and stamp duty All amounts include GST (if any). If the GST law changes after the date of your contract any amounts that include GST will be adjusted to reflect the change in the GST law. You will also need to pay us any stamp duty which is payable in relation to your contract, up to a maximum of $ General Our Customer Terms apply to all Telstra services relevant to your TMB plan. The offers specified in this plan are not available with any other Telstra offer unless we specifiy otherwise. You must pay the charge set out in Our Customer Terms if you port your TMB service number awayfrom Telstra.

5 TELSTRA ID REQUIREMENTS FOR A POST PAID TELSTRA MOBILE SERVICE 100 POINTS REQUIRED Personal applications (private and sole traders) All applicants must provide one form of Original Primary Identification and a minimum of one form of Original Secondary Identification. Requirements are split into primary and secondary. Note: ID sighted must be current, achieve a minimum of 100 points and be an original copy. PRIMARY ID Australian passport Australian drivers licence with photo and signature (WA drivers licences accepted) AVAILABLE POINTS Police/defence force ID (with photo) 60 Credit card 50 Blind Citizens Australia identity card Shooters licence Birth certificate or original birth extract (need marriage certificate if name changed through marriage) International passport date of visa must expire after the contract end date UNACCEPTABLE ID The following forms of ID are amongst those considered as unacceptable for both personal and company accounts: Any identification which has expired Photocopies of ID Club cards (eg RSL, AFL, league clubs, etc) Non tertiary student ID Frequent flyer cards Store cards (eg Myer/Grace Bros, David Jones, Katies, Cash Converters, Sportsgirl, Esprit, etc) Housing commission/rent assistance cards or passbooks Business cards Group certificates NSW birthcard 50 0 SECONDARY ID Current Telstra customer greater than 12 months*+ AVAILABLE POINTS Aged pension card Credit, debit, ATM cards* (Australian financial institution cards only) Mortgage documents* (letter of offer/contract) Only one form of ID may be sourced from document types marked with an *. For example, one credit card and/or one rate notice will be accepted. + Customer must show bill less than 6 months old Certificate of Title* 5 Valid Australian proof of age 5 Tertiary student ID card with photo 25 Social security card 25 Disability pension card 25 Health care card 25 Private health insurance membership card* Paper drivers licence (eg interim licence) 25 Employment ID card (with photo) Employment ID card (without photo) 0 Drivers licence (international/overseas) 25 Adoption or marriage certificate* 25 Electoral roll records* 25 Medicare card* 25 Local council rates notice* 25 Statement of account from financial institution* Gas, electricity, vehicle registration bills less than 12 months old* Company and government accounts All applicants must provide a letter of Authorisation/Purchase Order (dated within 60 days of purchase) plus one form of Original Primary Identification and a minimum of one form of Original Secondary Identification. Note: Original Authorisation Letter on original company letterhead or Purchase Order signed by the company representative. PRIMARY ID Australian passport Australian drivers licence with photo and signature (WA drivers licences accepted) AVAILABLE POINTS Business rules New post-paid connects on Next G, G and GSM networks. Does not include pre-paid services. Does not include handset upgrade to an existing active service. Telstra reserves the right to change or withdraw any part of the identification criteria without any prior notice. Corporate customers Existing Corporate or Government customers and their authorised representatives who have an established agreement with Telstra, ie, 6 months, will NOT be required to undergo the full 100 point ID check. An original letter of Authorisation or Company Purchase Order must still be provided. The representative must produce a security pass or company ID, the details of which should be recorded on the application. New corporate or government accounts must complete and submit the 100 points ID requirement. Current Telstra mobile customer upgrading to a contract All applicants must provide one form of Original Primary Identification or two forms of Original Secondary Identifications. Note: Company upgrades require a letter of authorisation/purchase order Credit card 50 Police/defence force ID (with photo) 60 Blind Citizens Australia identity card Shooters licence (with photo and signature) International passport date of visa must expire after the contract end date Note: ID must be current. Customer must supply bill less than 6 months old SECONDARY ID AVAILABLE POINTS Telstra company account greater than 12 months 70 Electricity company account less than 6 months old Gas company account less than 6 months old Water company account less than 6 months old Local council company rates account less than 6 months old Company credit card Employment ID card (with photo) Employment ID card (without photo) 0

6 TELSTRA NEXT G MOBILE BROADBAND NETWORK SHARED PLANS APPLICATION FORM 01 TELSTRA MOBILE BROADBAND ( TMB ) SERVICE DETAILS TMB service number 0 : 9 : 8 : 9: : 8 : 9 : 2 : 0 : 7 Choose one TMB shared plan: Shared Plan Monthly Casual Shared plan (do not include subsidised TMB device) $59.95 $74.95 $ Month Standard Shared plan (include partially or fully subsidised TMB device) $44.95 $54.95 $94.95 Amount payable by you upfront (applied to your first Telstra bill) for TMB device (if applicable) $ 24 Month Member (SIM Only) Shared Plan (do not include subsidised TMB Device) $9.95 $49.95 $89.95 TMB shared plan end date / / USIM serial number TMB Modem/Mobile Wi-Fi/Tablet/Wireless Gateway/Embedded Laptop (if purchased): Manufacturer/brand Model IMEI 02 ACCOUNT HOLDER DETAILS Account name/account holder Title Surname Given name Trading name (if applicable) Account holder address ACN/ABN/ARBN Period at current address Phone number Fax number Years Months Is the phone number silent Yes No Previous address (if less than 12 months at present address) Period at previous address Phone number Fax number Years Months Billing address (if different to account holder address) address Citizen SAMPLE FORM Years of incorporation (companies only) Industry type (if applicable) John

7 0 ADDITIONAL DETAILS FOR ACCOUNT HOLDER a) Other Telstra services in account holder name (b) Personal, Sole Trader, Partnership and Unincorporated Accounts only Main purpose of Service Business Residential Status Personal Renting Owner/Buyer Living with Parents Boarder Overseas Visitor Other (if applicable) Occupation Employer s Phone Number Employer Length of Employment Years Months b) Personal identification Enter details in relevant fields (eg, do not enter credit card number if used) Date of birth / / Primary (at least one form) Secondary (at least one form) Total points (must be 100 minimum) DOCUMENT TYPE POINTS DOC/ACC.NO. DATE ISSUED EXPIRY DATE 04 USER DETAILS (IF DIFFERENT FROM ACCOUNT HOLDER DETAILS IN 2) Title Surname Given name 05 COMPANIES, INCORPORATED ASSOCIATIONS & GOVERNMENT DEPARTMENTS (IF THE APPLICANT IS NOT AN INDIVIDUAL) Verified ID of representative (eg employee card, corporate credit card) Type of ID Full name Letter of authorisation or Purchase order no. Directors, committee members or authorised government representatives (if different from account holder details) Surname Given name Phone number 06 Exipry date / / MOBILE REPAYMENT OPTION (APPROVED MONTHLY CASUAL AND MEMBER PLAN CUSTOMERS ONLY) Customers must ensure that the Mobile Repayment Amount selected is equal to or less than the TMB device (incl. GST). TMB device (incl. GST): $ Mobile Repayment Amount selected (credit): $ Amount payable by you upfront to the dealer or Telstra store $ (difference between the TMB device and the Mobile Repayment Amount incl. GST) Mobile Repayment Option Term: SAMPLE FORM 12 mths 24 mths Other (if available) I agree to pay the monthly repayment amount (Mobile Repayment Amount divided by months in Mobile Repayment Option Term) of $ * for * months to Telstra, in return for Telstra paying the Mobile Repayment Amount to the Dealer or Telstra store on my behalf to contribute to the upfront cost of a TMB device (and/or any eligible mobile accessories). * Final monthly repayment may be higher to cover total Mobile Repayment Amount.

8 07 DEALER AUTHORISATION I am satisfied that the details provided on this form apply to the Account Holder and that the Account Holder/Authorised Signatory has shown me 100 points of current identification (in original form) to meet Telstra s ID requirements. I confirm that I have provided a copy of the Business Important Information Your Rights and Obligations Booklet ( Booklet ), and the relevant My Offer Summary to the Authorised Signatory/Account Holder. If this application relates to connection of a 24 month Shared Plan which includes a subsidised TMB device, I nominate the equipment described above for participation in the promotional package. Dealer/Agent NAC operator Sarah Premise code Telstra Shop 2 : K : 2 : 7 Name of dealer/agent representative (please print) John Citizen Signature of dealer/agent representative 08 IMPORTANT TERMS TO BE READ BY ALL APPLICANTS Authorisation no Date 01 / 01 / 12 Important: Please read these terms, the terms on the back of this form, the My Offer Summary we give you and the Booklet. If there is anything you don t understand, please speak to the dealer or us. By signing this form, you are acknowledging that you have read and agree to be bound by the terms in this form, as well as Our Customer Terms. You agree: You are responsible for any use of your Telstra service, whether you authorise it or not. Under Our Customer Terms, we can change the terms and prices of your plan. The summary of Our Customer Terms sets out how we can do this. If you use your Telstra service overseas, you will be charged for international roaming. If you use mobile data services overseas, it won t come out of your included data, and unless you take up a separate plan, you will be charged $15.6 per MB. We have explained to you that you will be charged for data you use in excess of, or which is not eligible to draw from, the included data on your plan. Our Customer Terms sets out the type of use which is not eligible. We have tools you can use to monitor your data usage and we recommend you sign up for these. You have received the Booklet which includes a copy of Telstra s Privacy Statement Protecting Your Privacy. All information you have provided in this application is correct. You may be able to use your Telstra mobile services to purchase goods, services or content from a third party. If you do so, Telstra will debit the charges for the content, goods or services from your account. If you don t pay Telstra when due, Telstra may cancel your service. Your TMB device is programmed to operate on the Telstra Next G network. An unlocking fee of $27.50 will apply if you wish to use your device on another network. That Next G coverage depends on your location, the device and if it has an external antenna. Coverage information on the Telstra Next G Mobile Broadband network is available from telstra.com (telstra.com/mobilebbcoverage). 09 ACCOUNT HOLDER ACCEPTANCE I warrant that all information in this application is correct. If I am not the Account Holder, I warrant that I am authorised to sign this form on behalf of the Account Holder. Account holder full name (please print) John Brown Date 01 / 01 / 12 Important Do not sign this application unless you have received and read the Booklet and the My Offer Summary. Only sign this section if you wish to proceed with your application. Account Holder/Authorised Signatory Mobile devices may interfere with sensitive biomedical electronic devices check with your specialist before use. SAMPLE FORM