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ID Exceptions

Re-Registration/Transfer
Mobile Phone Service
Complete this form if you are applying for a mobile phone service Date: ..............................

Please select one: Re-registration Transfer of Subscription Contact No.: ................................

Subscriber details
Full Name of Applicant Mr/Ms/Mrs:

P.O. Box: Emirate: Email: Nationality:

ID Document Type: Labour Card Diplomat Card

ID Document No.: Date of Issuance (dd/mm/yyyy): Date of Expiry (dd/mm/yyyy):

Visa No.: Date of Issuance (dd/mm/yyyy): Date of Expiry (dd/mm/yyyy):

Unied No. (required in case of Passport): Residency File No.:


Date of Birth (dd/mm/yyyy): Gender: Male Female Working No.:

I would like to receive SMS updates about Etisalats promotions & offers: Yes No

Existing Mobile Number(s):

SPOC/Delegate details
Power of Attorney Letter of Delegation

ID Document Type: Emirates ID Passport GCC ID

ID Document No.: Date of Issuance (dd/mm/yyyy): Date of Expiry (dd/mm/yyyy):

Unified No. (required in case of Passport): Residency File No.: Nationality: Emirate:

P.O. Box: Date of Birth (dd/mm/yyyy): Gender: Male Female Contact No.:

Transfer subscribership
Full Name of New Applicant Mr/Ms/Mrs:
P.O. Box: Emirate: Email: Nationality:

ID Document Type: Emirates ID Passport GCC ID Labour Card Diplomat Card

ID Document No.: Date of Issuance (dd/mm/yyyy): Date of Expiry (dd/mm/yyyy):

Unied No. (required in case of Passport): Residency File No.:


Date of Birth (dd/mm/yyyy): Gender: Male Female Working No.:

I would like to receive SMS updates about Etisalats promotions & offers: Yes No

Declaration
I/We agree to update my/our profile(s) with either an Emirates ID, Passport or GCC ID by visiting an Etisalat Business Centre before December 31, 2013.
Authorisation: I have read and agree to the Terms and Conditions

Employee Signature
Original Document Seen & Verified with the
Subscriber Signature Company/Retail Shop Stamp Copy Submitted New Subscriber Signature

For internal use


KR/RD Code: KR/RD/MR Store Code: KR/RD/MR/Sales Staff Code:

Request No.: Sub Request No.: Party ID: Authorised Management Signature:

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Terms and Conditions
ID Exceptions
Re-Registration/Transfer
Mobile Phone Service
Verification of identity of subscriber

The Customer undertakes to provide proof of identity and other information in the form required by Etisalat at the time of purchase of a SIM card from Etisalat and
warrants all documentation and information provided is true and valid. The Customer will solely be responsible for any untrue information or documentation provided
in violation to this Clause.

The Customer acknowledges that Etisalat will record details of the SIM card supplied with the product along with their proof of identity and information. The Customer
gives permission for this information to be shared with public agencies of the UAE for verification of identity and other lawful purposes.

Where Etisalat has supplied a SIM card to a Customer and registered details of that SIM card against the information of that Customer, the Customer warrants that
it will be the only person or entity that uses the SIM card. The Customer will be responsible for any use of the SIM card by any other person or entity. This includes
financial liability as well as responsibility where the SIM card is used for unlawful purposes.

The Customer warrants not to transfer the SIM card without the prior written permission of Etisalat.

Where the SIM card supplied to a customer (the Original Customer) comes to be used by a person or entity other than the Original Customer (the Existing Customer),
the Original Customer undertakes to inform Etisalat in due course about such change in usage of the SIM card. Etisalat may at its own discretion change its records,
including the registration form to reflect the information of the Existing Customer using the SIM card as the actual subscriber of the SIM card, provided that the
Existing Customer has given consent in writing to hold the subscription of the SIM.

Despite the abovementioned condition if Etisalat has received a request during the registration campaign from a SIM card user being not the registered Customer of
the same, Etisalat may grant a temporary registration in the name of the User subject to the following conditions:

1. The User has signed a declaration in a form satisfactory to Etisalat confirming that it obtained the SIM card lawfully, in good faith and with the consent of the
registered Customer or without its objection.

2. The Original Customer is unreachable to give consent for the change of the registration.

3. Etisalat reserves the right to cancel the temporary registration, without informing the Existing User, at any time during the registration campaign or six months
after the expiry of the same if the Original Customer has appeared and claimed the SIM card. The Existing User shall be liable for any legal & financial obligations
resulting from the use of the SIM card between the time of the temporary registration up to the date of deregistration.

4. The Existing User acknowledges that his registration is temporary and could be cancelled at any time at the discretion of Etisalat.

Disclaimer
When completing the application to replace the registered customer, the User shall bear in mind the consequences of making misleading or incorrect statements in
law and under the regulatory framework, as both prevent:
1. Making a statement and/or promise known to be misleading, false or deceptive in a material particular; or
2. Dishonestly concealing material facts; or
3. Intentionally or negligently making a statement, promise or likewise for the purpose of inducing Etisalat to offer the User the opportunity to obtain the registration
of the SIM card or to wrongfully transfer subscription of a SIM card.
In light of the above the User acknowledges that he/she will be solely responsible for any fraud, offence, violation, loss, breach of legal duty, breach of contract, legal
cost or any liability involving the statements made in this application, whereby the entry of his/her details in Etisalats database will replace the details of the actual
subscriber of the SIM card, and the User undertakes to indemnify, defend and hold Etisalat harmless against the same.
Authorisation: I have read and agree to the Terms and Conditions

Subscriber Signature Company/Retail Shop Stamp

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