Subscriber contract Customer Centre 800 73 73 73 www.t-mobile.cz/kontakt Customer contract Telephone number Subscriber contract Customer Centre – Business 800 73 73 33, business@t-mobile.cz www.t-mobile.cz Operator T-Mobile Czech Republic a.s. Tomíčkova 2144/1, 148 00 Prague 4 Company ID no. 649 49 681, VAT no. CZ64949681 Incorporated in the Commercial Register maintained by the Municipal Court in Prague, Section B, Insert 3787 Sales outlet code Sales rep., code, address Agent, code Seller’s outlet, code Details about the corporate entity, individual – entrepreneur Details about the individual, responsible party or party authorised to act on behalf Potential customer of the corporate entity. Trading name Street City Postcode Company ID no. VAT no. Representative Name, surname, title Street City Postcode Personal ID no./DOB1) Nationality Document – number – validity Contractual arrangements Name, surname, title Street City Postcode Personal ID no./DOB1) Nationality Doc. 1 – number – validity Doc. 2 – number – validity The Operator and the Potential customer hereby conclude a Subscriber contract, on the basis of which, the Operator shall provide the Potential customer with Basic and additional Electronic communication services and other services offered, this being in the scope which the Contracting parties agree on, and the Potential customer undertakes to pay the agreed price for these services. 2) The Operator and the Potential customer agree on a period of duration of the Subscriber contract for a definite period lasting months. The agreed period of duration shall begin on the date of activation of the arranged Services. 2) The Potential customer agrees to automatic prolongation of the Subscriber contract once the agreed definite period has expired, this again being for a definite period in accordance with the business terms and conditions of the selected tariff, if such prolongation of the Subscriber contract is regulated for by the business terms and conditions of the selected tariff, or tariff which the Potential customer selects over the duration of the Subscriber contract. In the event of disagreement with automatic prolongation of the Subscriber contract for a definite period or if the business terms and conditions of the selected tariff do not regulate for automatic prolongation for a definite period, the Subscriber contract shall be prolonged for an indefinite period. 2) The Operator and the Potential customer have agreed a period of duration of the Subscriber contract for an indefinite period. The content of the Subscriber contract and an integral part of the Subscriber contract shall be constituted by the documents specified on the second page of this form in the “Content of the Subscriber contract” section (hereinafter referred to only as “Documents”). By signing the Subscriber contract, the Potential customer confirms that all these Documents are known to him and that he agrees to them without reservation. With a view to the New Civil Code, the Operator would like to point out to the Potential customer that certain Documents contain provisions which may be regarded as surprising. These provisions are always highlighted in the Documents (in particular by being underlined). The Potential customer declares that he has familiarised himself in detail with these provisions and that he agrees to them without reservation. The Potential customer undertakes to familiarise himself with the conditions of all Services which he activates over the duration of the Subscriber contract, whereas the conditions of activated Services shall become an integral part of this Subscriber contract at the moment of activation of the Service in question. The Potential customer and the Operator agree on the contractual penalties specified in art. 8.1 of the General Terms 01-ACC-0-43 Form valid from 23. 3. 2014 1/4 and Conditions for the event of breach of obligations resulting from the Subscriber contract, whereas in accordance with this article, the Operator shall be entitled to charge the Potential customer a contractual penalty in the amount of CZK 150.00 if the Potential customer is in delay with payment of a Bill by one day and a contractual penalty in the amount of CZK 1,000.00 if the Potential customer is in delay with payment of a Bill by 21 days, and also those specified in art. 8.2 and 8.4 of the General Terms and Conditions. In the event of early termination of the Subscriber contract for other reasons than delay in settlement of monetary debts, the Potential customer shall be obliged to make the payments as specified in art. 8.3 of the General Terms and Conditions (also including settlement of the whole amount of the purchase price of Equipment still outstanding, if the Potential customer purchased the equipment in instalments). The Potential customer concludes a purchase contract with the Operator for end user equipment IMEI …… type3) (hereinafter referred to only as “Equipment”), this being subject to advantageous conditions which the Potential customer gains due to conclusion of this Subscriber contract. The Potential customer and the Operator have agreed on settlement of the purchase price of the Equipment in the form of regular monthly instalments in accordance with the Rules for sale in instalments and in accordance with the following instalment schedule: Total price of the Equipment Down payment (first instalment paid on acceptance of the Equipment Amount remaining to be paid Level of monthly instalment Remaining number of monthly instalments CZK CZK CZK CZK The due date for monthly instalments shall be governed by the due date of individual Bills. Failure to pay the respective instalment on its due date, or commencement of insolvency proceedings with the Potential customer in accordance with Act no. 182/2006 Coll., or termination of the Subscriber contract before expiry of its period of duration, for which notice of termination was given by the Potential customer, shall lead to all still outstanding instalments becoming due. 2) The Potential customer agrees to publication of Data in telephone directories and information services of entrepreneurs who provide these services. 2) The Potential customer requests that it be specified by details in the telephone directory that he does not wish to be contacted for the purpose of marketing. 2) The Potential customer agrees to being sent commercial messages and provision of marketing information containing offers of services and products of the Operator in accordance with the Conditions of processing of personal, identification, operational and localisation data (hereinafter referred to only as “PZOÚ”). 2) The Potential customer agrees to sending of commercial messages and to provision of marketing information containing offers of services and products of other entities different from the Operator in accordance with the PZOÚ. 2) The Potential customer is a “politically exposed person” within the meaning of Section 4, para. 5 Act no. 253/2008 Coll. 2) The Potential customer agrees to the Operator acquiring information about his payment discipline necessary to assess his application for conclusion of a Subscriber contract, this being from the negative database of the SOLUS association (www.solus.cz), which the Operator is a member of, and also agrees that the Operator is entitled to hand over Data to the SOLUS register of debtors in the event of repeated delay in payment or the existence of any monetary receivables more than 90 days overdue. 2) The Potential customer agrees to the Operator acquiring information about his payment discipline necessary to assess his application for conclusion of a Subscriber contract, this being from the positive database of the SOLUS association (www.solus.cz), which the Operator is a member of, and also agrees that the Operator is entitled to hand over Data to the SOLUS positive register, this being in the scope and for the purpose specified in article 5. of the Conditions of processing of personal, identification, operational and localisation data of subscribers. Content of the Subscriber contract (priority of Documents shall be governed by art. 2.2 of the General Terms and Conditions, not the order shown below) - - conditions captured in this form, including conditions agreed in the Service settings part of the form, valid version of the General Terms and Conditions of T-Mobile Czech Republic a.s. (hereinafter referred to also only as the “General Terms and Conditions”), valid Conditions of processing of personal, identification, operational and localisation data, valid Price list of services, other conditions: - Conditions of the selected tariff and other selected Services, Conditions of transfer of a number, Business terms and conditions of the T-Mobile service m-payment, Business terms and conditions of Payment services of T-Mobile Rules for sale of equipment in instalments All conditions are available at www.t-mobile.cz/novyzakaznik. The Potential customer and the Operator have agreed that information on conclusion of and changes to the Subscriber contract shall be sent by the Operator to the Potential customer to the T-Box located in the customer account of the Potential customer on the My T-Mobile portal (hereinafter referred to only as the “T-Box”). Until the moment of activation on the My TMobile portal, the Potential customer shall find information about the Subscriber contract in the temporary T-Box on the www.t-mobile.cz/t-box website, this being after entry of the number of the Customer contract (this is specified in the header of this form), the number of the Potential customer’s personal ID document specified in this Subscriber contract and the country of issue of this document. Confirmation sent to the T-Box shall not be regarded as a confirmative commercial letter. The Operator shall also not take into consideration confirmation of conclusion of a Subscriber contract sent by the Potential customer and such confirmation shall thus have no impact on the content of this Subscriber contract. If the Subscriber contract was concluded outside of premises usual for doing business or using remote communication means, the Potential customer shall be entitled to withdraw from it within 14 days of the date following delivery of information on conclusion of the Subscriber contract to the T-Box. Notice of withdrawal must be sent to the address of the sales 01-ACC-0-43 Form valid from 23. 3. 2014 2/4 representative specified in this form. If the address of the sales representative is not specified, notice of withdrawal must be sent to the address: PJ Expedis spol. s r.o.; Logistické centrum T-Mobile; areál Pragorent (hala č. VS32); Františka Vítězslava Veselého; 193 00 Praha 9. The Potential customer hereby explicitly declares that he asks the Operator to commence performance of his obligations before expiry of the stipulated deadline for withdrawal. Signatures Date Potential customer Operator/Sales representative 1) If the Potential customer does not have a personal ID number, enter the date of birth. 2) Applies if the column is marked with a cross. 3) Enter the precise name of the equipment which is the subject of sale in instalments. 01-ACC-0-43 Form valid from 23. 3. 2014 3/4 Service settings Customer Centre 800 73 73 73 www.t-mobile.cz/kontakt Telephone number SIM card number Activation Customer Centrum – Business 800 73 73 33, business@t-mobile.cz, www.t-mobile.cz Tariffs, services and other settings Migration Tarif Roaming tariff Private (additional) offer Data roaming limit1) Mobile internet Shared internet select tariff Audiotex and premium SMS DMS a SMS payment M-payment BlackBerry Internet Service Company network Extra minutes package2) Extra SMS package2) Off-peak calls Student User under the age of 18 let3) Basic offer of services Porting select select Personal ID no. of the user Bonus for the disabled Name, surname of the recipient Personal ID no. of the user Not possible to use roaming and other services4) Language for communication Language for voice mail English Sponsor Sponsored tel. nos. 5) 5) 5) English 5) T-Mobile Family Telephone numbers Internet Complete – tel. number of voice SIM Correspondence address6) Contact details and password of responsible party Billing and payment for services Trading name Name, surname, title Street City, postcode Name, surname of resp. party Administrator tel. no. Contact telephone no. E-mail Password of new resp. party (numerical)7) Password of current resp. party Password for blocking (numerical) Billing for services Detailed call statement Method of payment8) Limit Potential customer’s bank Account no./bank code Associate to existing Billing electronic none bank transfer CZK Price of activation/migration Service deposit Deposit for int. roaming Other deposits Total CZK 0 CZK 0 CZK 0 CZK CZK / Special services APN Internet Public (GPRS/EDGE/3G) Static public IP (GPRS/EDGE/3G) Internal data for processing by T-Mobile Activation code Type of SIM card Activation of numbers in order Type of number . . . Regular Note 1) Monthly limit for data roaming, the default value is 1,450 CZK. The Limit can be changed at MTM. Data roaming is blocked after cross the limit. 2) Packages are intended for With us tariffs and are for an indefinite period. 3) Only filled in for the BAV SE tariff with My 5 or Student addon. credit. 6) Only fill in if different from the registered office, place of business or residence address 4) In accordance with the conditions of the “Basic offer of services” which you will find at http://t-mobile.cz. 5) Cross off if you want to sponsor the number only in the event of insufficient 7) Only fill in if a new responsible party is being determined. 8) Payment by collection from a payment card will be performed after T-Mobile receives a confirmed authorisation form from the subscriber. If electronic Billing is selected, it is not possible to have postal order set as the method of payment. 01-ACC-0-43 Form valid from 23. 3. 2014 4/4