E-CUSTOMER ACQUISITION FORM

PART A : INFORMATION

1(a) Subscriber ID 1410779670

1(b) Subscriber Name D Sushila

2. INSTALLATION ADDRESS

2(a) Building Name

2(b) Address Line-1 door no 1-1-781/B/1/A , new gandhi nagar Near canra bank kabadi guda sec

2(c) Address Line-2 door no 1-1-781/B/1/A , new gandhi nagar Near canra bank kabadi guda sec

2(d) Landmark

2(e) City Hyderabad 2(f) District Hyderabad

2(g) State Telangana 2(h) Pincode 500081

3. REGISTERED MOBILE NUMBER (OPTIONAL)

3(a) 7993135580 3(b) 9515417441

4. Email vg.dosapati@gmail.com

PART B: SERVICE SUBSCRIPTION RELATED INFORMATION

1. DETAILS OF SERVICES SUBSCRIBED

1(a) Pay Channels/Pay Bouquets

1(b) Bouquets of FTA channel FTA Packs | DD Bouquet

1(c) Lock in period One Day

2. NETWORK CAPACITY FEE

2(a) Number of SD channels subscribed 1

(Note: 1 HD channel =2 SD channel)

Network Capacity Fee (NCF)

2(b) Rs.130/- + GST = Rs.153.40
(Note:
NCF=Rs.130/- for 0-200 channels
NCF=Rs.160/- for >200 channels)

3.MODE OF PAYMENT (PRE-PAID OR POSTPAID Prepaid

4.SUBSCRIPTION AMOUNT TO BE PAID 153.30

PART C: CPE RELATED INFORMATION

1. Scheme opted
(Other schemes- CPE (including STB) Outright Purchase

2. CPE Category (Choice: CPE including ODU / CPE CPE Including ODU
without ODU) (ODU: Outdoor Unit)

3. Monthly rental for CPE (Rent scheme) NA

(Advance Rental for Y months) and Nil Rental
after Y months
4. Refundable security deposit for CPE if any NA

5. Retail price of CPE 0.00

(Sale /any other scheme)

6. VC Number 000604949354

7. Type of set top box HD

8. Warranty 1 Year

PART D: CUSTOMER CARE CENTRE RELATED INFORMATION

1. Customer care Centre numbers 1860-120-6633

2. Toll free customer care Centre number 1800-208-6633

3. Customer care Centre e-mail help@tatasky.com

PART E: DETAILS OF PAYMENT MADE

1. Total Amount paid 153.00

2. Refundable security deposit, if applicable NA

3. Monthly rental for CPE and period of rent if NA

applicable

4. Retail price of CPE in case of outright purchase NA

scheme or Other scheme

5. Installation Charge Rs.100 + GST

6. Activation Fee Rs.50 + GST

DECLARATION BY CUSTOMER
I/We have read and understood all the terms and conditions of services mentioned herein / overleaf and unconditionally accept them as binding on
me/us. I/We also understand all the tariffs, rates, charges and related terms and conditions at which services are provided to me/us by Tata Sky
Limited as applicable as on this date and as amended from time to time. I/We hereby undertake to pay all charges on account of services availed by
me/us. I/We confirm that the information supplied is authentic and if found otherwise then Tata Sky Limited reserves the right to withdraw all the
services provided to me/us without any notices or assigning any reason and I/We undertake to indemnify Tata Sly Limited for the loss which it might
have suffered on account of providing the said false information or giving wrong facts. I acknowledge and agree that the ‘Customer Premise
Equipment’ (CPE) which has been installed in my premises is under my sole legal control, possession and perpetual ownership and is installed only
for the express purpose of availing the DTH services of Tata Sky and such other services provided by Tata Sky. I undertake not to use the CPE for any
other purposes. I undertake to keep Tata Sky informed of any changes in the information shared with Tata Sky. I undertake not to relocate the CPE
without informing Tata Sky I undertake to be solely responsible for the acts of my Authorised Representative and for acts of all other person who
avail the Tata Sky Service through me or through the CPE. I shall be solely responsible to take care of the CPE and to comply with all the instructions,
terms and conditions mentioned in the Subscription Contract, user guides, manuals and/or service catalogues.

Acceptance Date & Time: 1/17/21 1:39:23PM