NGNBN Subscription Application Business Users

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1 NGNBN Subscription Application Business Users Particulars of Company/Business/Society Name of Company/Business/Society(as in ACRA/ROS Registration) ACRA UEN No/ ROS no. Name of Authorized Officer NRIC/Passport Number Designation address Fax No Telephone/Handphone No Billing Address Billing Address Billing address is the same as Installation Address Name of Billing Contact Telephone/Handphone & Fax No address Postal Code Site Address Installation Address ( If different from billing address) Site Contact for Installation Appointment Name Telephone/Mobile Phone No Address Postal Code S/N Subscription Plan 1 24-month subscription to SuperInternet NGNBN Basic -100Mbps Internet Access Service over NGNBN on best effort basis* Amount to be paid in monthly installments of $ (S$178 before GST) via GIRO over the duration of the $ One-time activation charge $1, month subscription to SuperInternet NGNBN Basic -100Mbps Internet Access Service over NGNBN on best effort basis* Amount to be paid in monthly installments of $ (S$198 before GST) via GIRO over the duration of the $ One-time activation charge $1, month subscription to SuperInternet NGNBN STATIC -100Mbps Internet Access Service over NGNBN on best effort basis*, inclusive of 1 Static IP address (IPv4) Amount to be paid in monthly installments of $ (S$228 before GST) via GIRO over the duration of the $5, One-time activation charge $1, *CPE and onsite support are not included as part of subscription Page 1 of 4

2 S/N 4 Subscription Plan 12-month subscription to SuperInternet NGNBN Managed -100Mbps Internet Access Service over NGNBN on best effort basis, inclusive of managed CPE and 8 x 5 x 4 onsite service Amount to be paid in monthly installments of $ (S$525 before GST) via GIRO over the duration of the $6, One-time activation charge $1, month subscription to SuperInternet NGNBN Managed -100Mbps Internet Access Service over NGNBN on best effort basis, inclusive of managed CPE and 8 x 5 x 4 onsite service Amount to be paid in monthly installments of $ (S$475 before GST) via GIRO over the duration of the $12, Activation Date One-time activation charge $1, As soon as possible. (Typical leadtime for service provisioning is 4-6 weeks.) I would like to delay activation to a later date Preferred Activation Date : *CPE and onsite support are not included as part of subscription Please check on to confirm that your address is Fiber Ready before submitting this form. The following documents (original) must be submitted and received by SuperInternet before order processing can commence: This Service Application Form, completed and signed Photocopy/Scan of front & back of I/C or Passport of Authorised Officer Photocopy/Scan of namecard of Authorised Officer GIRO application form (on Page 3), completed and signed Payment for One-time activation charge (via Cheque or Paypal or NETS) S/N 1 Value Added Services (VAS) VAS : Static IP Address for MANAGED 12 month subscription to 1 STATIC IPv4 IP Address with SuperInternet NGNBN Managed Amount to be paid in monthly installments of $10.70 (S$10 before GST) via GIRO over the duration of the One-time activation charge $ VAS : Static IP Address for MANAGED 24 month subscription to 1 STATIC IPv4 IP Address with SuperInternet NGNBN Managed One-time activation charge $ VAS : Additional /29 Static LAN IP for Static Plan 12 month subscription to Additional /29 Static IPv4 LAN IP Address with SuperInternet NGNBN STATIC Amount to be paid in monthly installments of $53.50 (S$50 before GST) via GIRO over the duration of the $ One-time activation charge $ VAS : Additional /29 Static LAN IP for Static Plan^ 24 month subscription to Additional /29 Static IPv4 LAN IP Address with SuperInternet NGNBN STATIC Amount to be paid in monthly installments of $32.10 (S$30 before GST) via GIRO over the duration of the $ One-time activation charge $ Page 2 of 4

3 S/N Value Added Services (VAS) VAS : Additional /28 Static LAN IP for Static Plan^ 12 month subscription to Additional /28 Static IPv4 LAN IP Address with SuperInternet NGNBN STATIC $1, Amount to be paid in monthly installments of $85.60 (S$80 before GST) via GIRO over the duration of the One-time activation charge $ VAS : Additional /28 Static LAN IP for Static Plan^ 24 month subscription to Additional /28 Static IPv4 LAN IP Address with SuperInternet NGNBN STATIC Amount to be paid in monthly installments of $53.50 (S$50 before GST) via GIRO over the duration of the $1, One-time activation charge $ VAS : IPv6 Addresses for Business 12 month subscription to IPv6 Address with SuperInternet NGNBN $64.20 One-time activation charge $ VAS : IPv6 Addresses for Business 24 month subscription to IPv6 Address with SuperInternet NGNBN One-time activation charge $21.40 Page 3 of 4

4 Other Charges The following charges shall be billed to you as and when the corresponding services are requested. Please ensure that you have in writing any subsequent agreement for waiver of those charges. Unless otherwise stated, the indicated charges are on a Per Line basis. No. Description Charges (SGD before GST) 1. Onsite technical support - During office hours - After office hours/weekend $ per hour (minimum 2 hrs) $ per hour (minimum 2 hrs) 2. Relocation of line to different address $1, $2, Relocation of line within same address $200 - $1,000 estimated. Subject to Site survey. 4. Change in subscriber s legal entity (subject to SuperInternet consent) $ Re-Activation of Service after Suspension (Next Business Day) $ Express Re-Activation of Service after Suspension (within 2 hrs) $ Late Payment, Reminder Charge $ Unsuccessful GIRO Deduction $10.00 Note : All prices listed are subject to prevailing GST rates. Service start date shall be approximately 4 weeks from receipt of order but may extend to 8 weeks in some circumstances. NGNBN Fibre is required for this service. Where Fibre Termination Point (FTP) is not already installed within the customer s premises, additional installation charges will apply. Kindly note that a 2 nd deployment charge of S$80.00 will apply if a schedule change request is received less than 24 hours from the original scheduled date for Onsite Troubleshooting service. Any handwritten notes purportedly modifying any clause or term or condition in this form shall be of no effect at the sole discretion of SuperInternet Services are provided subject to our standard terms and conditions as published at TUhttp:// UTH Any other charges levied on SuperInternet by OpenNet, whether directly or through Nucleus Connect, whether due to action or inaction on your part, shall be charged back to you at cost + 8%. Please refer to Annex 6 section 2 of the Nucleus Connect ICO as found on the IDA website at for more details Agreed By: (Name/Signature/Designation) Company Stamp Referred By : Date: For Official Use Only : Plancode : Order accepted & approved by : Remarks : AM/CAM Verified Deployment Date DB Updated Prep Inv Eqm Allocated Apvd to deploy Fin/Adm Apvd Line Ordered Acct created Cfg Tested ACCESS - S_NGNBN100M_BIZ-2010Q3 Ver 1.0 Page 4 of 4

5 APPLICATION FORM FOR INTERBANK GIRO Kindly complete & return original form to SuperInternet Access Pte Ltd PART 1: FOR APPLICANT S COMPLETION Date Customer s Name To: Name of Financial Institution Branch GIRO Customer Reference (Allocated by SuperInternet) (a) I/We hereby instruct you to process SuperInternet Access instructions to debit my/our account. (b) You are entitled to reject SuperInternet Access debit instruction if my/our account does not have sufficient funds and charge me/us a fee for this. You may also at your discretion allow the debit even if this results in an overdraft on the account and impose charges accordingly. (c) This authorisation will remain in force until terminated by your written notice sent to my/our address last known to you or upon receipt of my/our written revocation through SuperInternet Access. My/Our Name(s) As in Bank Account My/Our Contact (Tel/Fax) Number(s): My/Our Bank Account Number: My/Our Company Stamp/Signature(s)/Thumbprint(s)* (As in Financial Institution s Records) PART 2: FOR SUPERINTERNET ACCESS COMPLETION Bank Branch SuperInternet Access Account No. GIRO Customer Reference Bank Branch Account No. to be debited To: PART 3: FOR FINANCIAL INSTITUTION S COMPLETION This Application is hereby REJECTED (please tick) for the following reason(s): Signature/Thumbprint# differs from Financial Institution s records Signature/Thumbprint# incomplete/unclear # Account operated by signature/thumbprint # Wrong account number Amendments not countersigned by customer Others: Name of Approving Officer Authorised Signature Date * For thumbprints, please go to the branch with your identification. # Please delete where inapplicable

Account Opening - Checklist. Applicant Name: Checklist. s/n Items " " Tick (when complete /furnish) 1 Financial Status (financial for past 2 years)

Account Opening - Checklist. Applicant Name: Checklist. s/n Items Tick (when complete /furnish) 1 Financial Status (financial for past 2 years) Account Opening - Checklist Checklist s/n Items " " Tick (when complete /furnish) 1 Financial Status (financial for past 2 years) 2 Application for Interbank GIRO 3 Declaration Form 4 Bizfile 5 PORTNET