SRI LANKA TELECOM PLC

Application for Sri Lanka Telecom PEO TV

To be filled by SLT staff

CR.No. C R

1.0 General Information

other
1.1 Name in full or Company Name Rev./Mr./ Ms.
(in block capitals)

1.2 Service Installation Address

1.3 National Identity Card No. / Business Registration No.

1.4 Designation (if it is a company)

1.5 Details of a Contact Person

1.5.1 Name

1.5.2 Contact Numbers Mobile

Office

Fax

1.5.3 E-mail Address

1.6 SLT Telephone Number for PEO TV Service

2.0 Package Details

2.1 Package Name PEO SILVER PEO SILVER PLUS PEO GOLD PEO ENTERTAINMENT

PEO PLATINUM PEO TITANIUM

2.2 Value Added Services

Monthly Rental Rs.
(Please mark "X" in appropriate box)

2.2.1 Time Shift TV ( TSTV) Required Monthly Subscription Fee Rs.

2.2.2 *Video on Demand ( VoD) Required Monthly Subscription Fee Rs.

2.2.3 Other Monthly Subscription Fee Rs.

* Relevent Charges will be applicable on the Services ordered.

3.0 Service Enabling Fee

3.1 Service Enabling Fee Rs.

4.0 Subscriber Certification

I/We agree to a Minimum Service Commitment period of twelve (12) months from the date of service provisioned and confirm that the
information provided herein is true and correct. I/We also confirm that I/we have read and understood the terms and conditions overleaf
and agree to abide them. I/We acknowledge that the CPE installed will remain the property of SLT at all times and that SLT is not liable
for any damage to the CPE caused by lightning or other acts of God and/or by high voltage/current and if lost/stolen or damaged or
mistreated or used improperly by me/us such repairing/replacing costs will be borne by me/us. I/We further agree that in the event of
premature termination of the service by me/us due to reasons other than for any technical defect attributable to SLT, I/we shall settle in
full all outstanding payments due to SLT including but not limited to the Monthly Rental for the unutilized period of the said Minimum
Service Commitment Period.

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Subscriber Signature Company Rubber Stamp Date