1.0 General Information

2.0 Package Details

3.0 Service Enabling Fee

4.0 Subscriber Certification

SRI LANKA TELECOM PLCApplication for Sri Lanka Telecom PEO TV

To be filled by SLT staffC RCR.No.

other

1.1 Name in full or Company Name

1.2 Service Installation Address

Rev./Mr./ Ms. (in block capitals)

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

1.5.3 E-mail Address

1.6 SLT Telephone Number for PEO TV Service

Mobile

Office

Fax

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

PEO PLATINUM PEO TITANIUM

2.2 Value Added Services(Please mark "X" in appropriate box)

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

Monthly Rental Rs.

2.2.3 Other Monthly Subscription Fee Rs.

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

* Relevent Charges will be applicable on the Services ordered.

3.1 Service Enabling Fee Rs.

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.

Subscriber Signature Company Rubber Stamp Date ............................................................ ............................................................ ..................................................