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_AGENT
DEALERCODE:
4
20
19
4_
7_
SNAME___________

DEALER
SNAME:
__________________EVENTCODE_____________

RECELLEPEREZ(
6343)7060200 CONTACTNO.
:______________

SUBSCRI
BER

APPLI
CATI
ON

FORM

pl
dt
home.
c
om/
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er
a

PLDT HOME ULTERA SUBSCRIPTION CERTIFICATE

ADDITIONAL TERMS AND CONDITIONS APPLICABLE TO PLDT HOME ULTERA
I confirm that I have read and understood the HOME Ultera terms & Condition found at http://shop.pldthome.com/Wireless/TermsAndConditions/ (Terms and Conditions) any
amendments, concerning my subscription.
I understand that in addition to the HOME Ultera Terms & Condition, the additional terms and conditions set forth below (Additional Terms and Conditions) shall also govern my
subscription to HOME Ultera:

36-Months Contract
The minimum subscription term to HOME Ultera in three (3) years (the Initial Term) starting from the date of activation. Should I wish I wish to terminate my subscription to
HOME Ultera prior to the end of the Initial Term, I shall submit a written request for pre-termination to smart Broadband Inc. (SBI) at least thirty (30) days prior to my intended
date of termination and pay the applicable pre-termination fees.

Renewal
After the Initial Term, my subscription to HOME Ultera shall automatically renewed under the same Terms and Conditions and these Additional Terms and Conditions, subject to
any amendments to such Terms and Conditions and these Additional Terms and Conditions that SBI may issue from time to time, unless I notify SBI of my intention to terminate my
subscription at least thirty (30) days before my intended date of termination.

Use of the Service

HOME Ultera is intended for personal, non-commercial use only, SBI reserves the right to amend my subscription to a commercial subscription should it discover that I am utilizing
PLDT HOME ULTERA for commercial purposes.

Service Quality
To achieve connection and service, I must not remove my HOME Ultera device from where it was originally installed by the HOME technician.

Customer Premise Equipment (CPE)

o Upon approval of my application, I will be charged Php 300.00 on top of the monthly service fee to cover the cost of the installed modem.
o The warranty period shall be limited to seven (7) days from date of installation. I will be liable for the cost of replacing or repairing the modem after the warranty period.
o SBI reserves the right to pull out the CPE in the event of disconnection with the following scenarios:
Voluntary disconnection within minimum subscription term of 36 months if the pre-termination fee is not settled.
Non-payment within minimum subscription term of 36 months which leads to disconnection.
Note: Applicable only for new subscribers.

Pre-termination Fee
In the event of disconnection prior to the end of the initial Term, I agree to pay the pre-termination fee computed using the following formula:
Pre- Termination Fee = (Monthly Service Fee + Device Fee) x unexpired term

Fees & Charges

I have availed of __________________________ (specify and check the plan type) and agree to pay below fees and charges in accordance with the following schedule:

FOR NEW HOME ULTERA SUBRIBERS

PLEASE
CHECK

PLAN TYPE

DEVICE CASH OUT

ULTERA FUN PLAN 699

ULTERA FUN PLAN 999

NO CASH OUT

DEVIC MONTHLY FEE

TOTAL MONTHLY FEE

MONTHLY VOLUME
ALLOWANCE

PHP 699.00

FREE

PHP 699.00

30 GB

PHP 1,099.00

50 GB

PHP 1,699.00

70 GB

PHP 999.00

ULTERA FUN PLAN 1599

MONTHLY
SERVICE FEE

PHP 100

PHP 1,599.00

Monthly Volume Allowance

I understand that I will be given a monthly data volume allowance for my HOME Ultera plan. Once I consume my data volume allowance for the month, I will ONLY be able to enjoy
access to the internet if I purchase Volume Boosters. I am aware that my volume allowance will be refreshed immediately the following month
I have availed of ___________________________ (specify the plan type) and my monthly volume allowance is as follows in the table above.

FOR MIGRATING CANOPY/WIMAX SUBCRIBERS ONLY:

Disconnection of Canopy/Wimax Account
I understand that by upgrading to Home Ultera, my Canopy/WiMax subscription will be terminated and that all Canopy/WiMax equipment will be pulled-out by SBIs contractor.
Pre-termination fee for my Canopy/WiMax account will be waived. But any unpaid balance will be carried over to my Ultera subscription, to be amortized equality across tree (30
months. Any remaining amortized device cost shall be carried over to my Ultera subscription following the same amortization scheme upon device availment.

DATE

ID TYPE and NUMBER

____________/____________/____________

ACCOUNT NUMBER

TELEPHONE NUMBER

SERVICE REFERENCE NO.

MOBILE NUMBER

Dealer Code : 4201947

_____________________________________
PLDT HOME Representative
Signature over Printed Name

_____________________________________
Subscriber
Signature over Printed Name
SPEED
Plan 699
Up to 3Mbps

Speed
Price
Volume

Plan 999
Up to 5Mbps

VOLUME BOOSTER PACKAGES

P49
1GB

P149
4GB

Plan 1599
Up to 10Mbps
P249
10GB

Requirement/s (Provide Photo copy)

PROOF OF IDENTIFICATION (PoID)

*Phil Passport/SSS/GSIS/TIN with Photo/Firearms License ID (Digitized/Card type

only)/Phil Drivers License/Unified Multi-purpose ID/PRC/IBP/OFW/DIPLOMAT
ID/AFP/PNP/NBI/PHIL AIRFORCE ID/TOP 2k Company ID/Alien Certificate
(Permanent)/ Locally-issued Credit Card (w/ or w/o picture)

Proof of Address (POA) Provide LETTER OF

AUTHORIZATION (LOA) if document is NOT under the
applicants name.

Electric/Water/Cable/Telco/Mobile/Credit Card/Bank Statement/Exclusive card

membership/Insurance