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Augere Wireless Broadband Bangladesh Ltd.

E‐mail: qubee@qubee.com.bd
Helpline: 02 8959911

Static Public IP Subscription Form
Form Serial Number :

Received from:

SS

CC

[A] TERMS & CONDITIONS
By submitting the following information, client is making a formal application for Static Public IP Address, which will become
binding upon confirmation from AWBBL and 3 working days will be taken to get back.
The person confirmed by the applicant as the technical contact will be communicated for any technical issues.
Please note AWBBL will not provide Static Public IP for: Browsing, Gaming Service & SMTP usage.
Static Public IP may not be allocated if the required service by the customer could be served by DHCP IP.
In case of abusing the network by using this static IP :

The respective client will be responsible for any unlawful activities.

AWBBL holds the right to investigate and close the service.

AWBBL holds the right to allocate the static IP to any other user if it remains unused for two month.

Terms & conditions mentioned in the original Subscriber Application Form (SAF) will also remain valid & applicable.
AWBBL will not be responsible for any business loss or any other consequence of the client in case of any temporary service
disruption.

[B] CUSTOMER INFORMATION
Account No.

Q U B E E

A/C Name

Phone No.

Email

Username

MAC ID.

Billing address:
[C] TECHNICAL INFORMATION
Package speed

Name of the Organization

Req. 1 mbps or above

Type of Business

No. of required IP

Technical Contact Name
Phone No.

Email

Please specify purpose of using static IP:

DNS Server

Domain Name

____________________________________________________

Mail Server

Domain Name

____________________________________________________

VPN Service

Source IP

_________________

Web Server

Domain Name

____________________________________________________

FTP Server

Domain Name

____________________________________________________

Other

Specify

____________________________________________________

Destination IP

__________________

STATIC PUBLIC IP SUBSCRIPTION FORM

1

the respective user will be responsible for that. the undersigned. E‐mail: qubee@qubee. □ NOC Allocated IP Address Date of Allocation Date of Expire 20 dd mm yy 20 dd mm yy Remarks Signature: STATIC PUBLIC IP SUBSCRIPTION FORM 2 . Signature: Received Documents □ Subscriber Application Form (SAF) □ Company trade license □ Application in company letterhead QUBEE Technology : Name of implementer Department □ IT Phone No. hereby certify that.    In case of any abusing through this Static Public IP.com. AWBBL has the rights to suspend that Static Public IP. AWBBL keep the full rights to allocate and take over the Static Public IP from any Qubee subscriber. AWBBL has the rights to investigate and close the service for that client. If the Static Public IP is unused for more than 2 months.Augere Wireless Broadband Bangladesh Ltd. Name: ____________________________________________ Designation: ___________________________________________ Contact Number: ___________________________________ AUTHORISED SIGNATURE (with company stamp/seal): _______________________________________ Date: _______________ FOR QUBEE USE ONLY QUBEE Head of Sales/Customer Service: Name Department □ Sales □ Customer Service Phone No.bd Helpline: 02 8959911 Static Public IP Subscription Form [D] SIGNATURE & DECLARATION OF THE COMPANY REPRESENTATIVE I.