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					ocean                                                                            Broadband Connect Service Application
                                                                                                                              ABN: 89 110 380 820
                                                                                                        Suite 7, 295 Rokeby Road, Subiaco, WA 6008
                        next generation broadband                                                              Tel: 08 9381 2226 Fax: 08 9467 6217



       Instructions: Please complete all the sections using BLOCK LETTERS and return it to
Ocean Broadband Limited, 295 Rokeby Road, SUBIACO WA 6008 or fax it to: (08) 9467 6217

  Customer       Surname                                                                         Given name(s)

    Details       Mr / Mrs / Miss / Ms / Other

                 Address



                 Suburb/Town                                     State                                       Post code



                 Preferred email user name – up to 12 characters, no spaces           Preferred contact phone number during daytime hours




Credit Card For all pricing and plan options see Account Options which sets out all matters in detail.
  Payment Please fill in the necessary details below:
    Details I authorise Ocean Broadband to charge my subscription fee and monthly access fees to my credit
                 card account as follows:



                 Tick card type:            Visa                    MasterCard
                 Card number                                                                          Expiration date (MM / YYYY)


                 Cardholder’s name as it appears on the card


                 Signature                                                                            Date




        Plan Tick the box below to indicate the Broadband Connect service that you require:
   Selection
                      256K Flat-rate             256K Premium                 512K Flat-rate          512K Premium             512K PAYG

                      1 Meg Turbo                1 Meg Turbo Plus             2 Meg Ultra             2 Meg Ultra Plus


                 PLEASE NOTE: Customer computers are required to be Ethernet network-enabled

 Terms and       The Customer Relationship Agreement and Acceptable Use Policy (available on www.oceanbroadband.net) set out the
                 obligations and rights of you as a user of the facilities offered by Ocean Broadband. These documents also set out in
 conditions      detail the obligations and rights of Ocean Broadband. Your signature below is your undertaking to accept the terms
                 and conditions of use of the Internet as set out in these documents.

                 Signature                                                                     Date




                    Australian Government                      IMPORTANT: Please also complete the attached
                    Broadband Connect                                     Broadband Connect form (“Form 1”)
ocean                                                                                                                                          Account Options
                                                                                                                                                    ABN: 89 110 380 820
                                                                                                                              Suite 7, 295 Rokeby Road, Subiaco, WA 6008
                                     next generation broadband                                                                       Tel: 08 9381 2226 Fax: 08 9467 6217


         Introductory offer: FREE Standard Install and subscriber modem on all Broadband Connect services
                   This is an information page outlining the details of our Broadband Connect service plans
    Please note that all the service plans below are subject to the Broadband Connect eligibility requirements and are subject to our Customer Relationship
   Agreement and Acceptable Use Policy (both available on request or on our website: www.oceanbroadband.net.au). Please ensure that you have read these
                   documents and are satisfied with the terms and conditions prior to ordering a service plan. All prices quoted include GST.

512K Pay-As-You-Go                       This plan is designed for those users who only have an occasional need to access a fast broadband
                                         connection, such as holiday home owners. While the service is not being used, all you pay is $7.90 per
  $7.90 / month admin fee                month. When you use the service, we charge 14¢ per Megabyte that you download or upload up to a limit
  512K/128K peak speed                   of 500 MB per month, at which point standard shaping* policies apply and we then cap your charges
  14c/MB to 500 MB                       (maximum $77.90/month). A one-off activation fee of $25 applies for this service.
  $25 Activation Fee

256K Starter                             This service is ideal for those users who want broadband at a budget price.
  $27.50 / month flat rate               The download speed for this service is up to 256 Kilobits per second (Kbps) and you can upload data at up
  256K/64K peak speed                    to 64 Kbps. You still get a generous monhtly download and upload limit of 500 Megabytes (MB) in peak
  500 MB peak threshold                  hours and a further 500 MB in off-peak hours. Once you reach this limit, the connection will be shaped*,
  500 MB offpeak threshold               instead of charging you excess usage fees. The service includes 5 email addresses.

256K Premium                              This service is ideal for those users who want broadband at a budget price but who also have a need for
                                          larger download quotas. The download and upload speed for this service are as per the 256K Starter Plan,
  $39.95 / month flat rate                however you get a significantly increased upload/download quota.
  256K/64K peak speed
  2000MB peak threshold                   Once you reach this limit, standard shaping* policies will apply, instead of charging you excess usage fees.
  2000MB offpeak threshold                The service includes 5 email addresses.

512K Flat-rate                            This service is ideal for those users who want fast broadband at a predictable price. The download speed for
                                          this service is up to 512 Kbps and you can upload data at up to 128 Kbps. The generous download limits
  $38.50 / month flat rate                support moderate levels of emailing and web-browsing. The monthly limit for download and upload volume
  512K/128K peak speed                    is 1,000 MB during peak hours (7am to 12 midnight) and a further 1,000 MB off-peak (12 midnight to 7am).
  1000MB peak threshold                   Once you reach either of these limits, our standard shaping* policies will apply, instead of charging you
  1000MB offpeak threshold                excess usage fees. All 512K plans include 5 email addresses.

512K Premium                              This plan suits those users who have more demanding upload/download requirements, but who still want
                                          broadband at a predictable price.
  $49.95 / month flat rate
  512K/128K peak speed                    The service is identical in all respects to our 512K Flat-rate service, except that the download/ upload limits
  2000MB peak threshold                   are increased. This means that you can download/upload up to 2,000 MB during peak hours and a further
  2000MB offpeak threshold                2,000 MB during off-peak hours before your account becomes subject to our shaping* policies.

1 Meg Turbo                               This is ideal for heavy users of the Internet who need a faster service and/or have more demanding
                                          upload/download requirements, but who still want broadband at a predictable price. 1Meg Turbo supports
  $59.95 / month flat rate                double the download and upload speed of the 512K plans: up to 1,024 Kbps peak download and 256 Kbps
  1024K/256K peak speed                   peak upload speeds This service allows you to download or upload a total of a generous 5,000 MB in peak
  5000MB peak threshold                   hours and a further 5,000 MB off-peak, before your account becomes subject to our shaping* policies.
  5000MB offpeak threshold

1 Meg Turbo Plus                          This plan suits those users who have even more demanding upload/download requirements, but who still
                                          want broadband at a predictable price.
  $69.95 / month flat rate
  1024K/256K peak speed                   The service is identical in all respects to our 1 Meg Turbo service, except that the download/ upload limits
  10000MB peak threshold                  are doubled. This means that you can download/upload up to 10,000 MB during peak hours and a further
  10000MB offpeak threshold               10,000 MB during off-peak hours before your account becomes subject to our shaping* policies.

2 Meg Ultra                               Our 2 Meg plans suit “power users” who have extremely demanding upload/download requirements
  $99.95 / month flat rate                The 2 Meg Ultra service offers a blazing up to 2 Megabits per second, with very large download quotas. You
  2048K/384K peak speed                   can download/upload up to 10,000 MB during peak hours and a further 10,000 MB during off-peak hours
  10000MB peak threshold                  before your account becomes subject to our shaping* policies.
  10000MB offpeak threshold               Not available in all areas.

2 Meg Ultra Plus                          This is our super-premium plan for users who have the most demanding upload/download requirements.
  $129.95 / month flat rate               The service is identical in all respects to our 2 Meg Ultra service, except that the download/ upload limits
  2048K/384K peak speed                   are doubled. This means that you can download/upload up to 20,000 MB during peak hours and a further
  20000MB peak threshold                  20,000 MB during off-peak hours before your account becomes subject to our shaping* policies.
  20000MB offpeak threshold               Not available in all areas.
* Shaping: Once your monthly limit is reached, speeds are reduced to 72Kbps. When 150% of your download limit is reached, speeds are further reduced to 33Kbps.
Form 1: Broadband Connect Customer Attestation Form



Section 1: Applicant details
Residential applicant:
Title:     .......................     Given name(s): .....................................................................
Surname:                     ..........................................................................................................
Telephone (b/h): .......................................                Telephone (a/h):....................................
Mobile:.......................................................          Fax: .......................................................
Email:                      ..........................................................................................................
                                                                                                                (Residential applicants, go to section 2)
Organisation applicant:
         Small Business
         Not-for-Profit organisation seeking a service for own use
         Not-for-Profit organisation seeking a service to provide a public access facility
         Indigenous Community Council
Organisation Name: .......................................................................................................
ABN: ....................................................... ACN: .......................................................
GST exempt:             YES/NO                Number of full time employees:                                      ....................
Number of public access points: ....................................................................................
Contact details
Title:     ....................................................... Given name(s): .......................................
Position: .....................................................         Surname: ..............................................
Telephone (b/h): .......................................                Telephone (a/h):....................................
Mobile:.......................................................          Fax: .......................................................
Email:                      ..........................................................................................................

Section 2: Address details
Broadband Connect Service Address:                                 where the service is required - not a postal address
Telephone number of Service Address:..........................................................................
Address Line 1:              ..........................................................................................................
Address Line 2:              ..........................................................................................................
Locality / Suburb: ..................................... State: ..............Postcode:                           ....................
Postal Address:                                                                       As Above, if same as Service Address
Address Line 1:              ..........................................................................................................
Address Line 2:              ..........................................................................................................
Locality / Suburb: ..................................... State: ..............Postcode:                           ....................
Physical Address:                                                                     As Above, if same as Service Address
Address Line 1:              ..........................................................................................................
Address Line 2:              ..........................................................................................................
Locality / Suburb: ..................................... State: ..............Postcode:                           ....................
                                                                          Page 1 of 3
Form 1: Broadband Connect Customer Attestation Form


Section 3:                    Eligibility
Checking of eligibility of Premises
To be eligible for a Broadband Connect Service, you must be an ‘Eligible Customer’ (as defined under the Broadband
Connect Guidelines); applying for a Broadband Connect Service at Eligible Premises (as defined) in a Broadband Connect
Area of regional Australia; and not have been able to receive a broadband internet service that was metro-comparable in
price, functionality and performance at those premises at the start of HiBIS on 8 April 2004.
1. Have you or your Service Provider checked whether your premises is located within a
   Broadband Connect Area by checking the maps on the Broadband Connect website at:
   http://sdndiscovery.dcita.gov.au/MIDiscovery/ ?
                                                                             Answer: YES / NO
If YES proceed to Q2. If NO, check eligibility, then complete the remaining questions below.
2. Where your premises are in an ‘amber area’ of the Broadband Connect maps, have you or
   your Service Provider checked with applicable pre-existing providers servicing your region
   whether relevant metro-comparable services are available to your premises?
                                                                               Answer: YES / NO
Previous provision of a Broadband Connect service to a particular Premises.
In general, any given Broadband Connect Premises may have a Broadband Connect Service connected to it only once. An
exception is that a ‘Residential Customer’ (as defined) is not precluded from being supplied with an additional Service at the
same premises as a Small Business Customer, subject to meeting eligibility requirements. An example of where this may
apply is where a person is operating a business from their home. Another exception is that where a HiBIS or Broadband
Connect Customer stops receiving a HiBIS or Broadband Connect Service at a particular Broadband Connect Premises
through circumstances beyond their control, the Customer may be eligible to be provided with another Broadband Connect
Service at that Premises. Refer to section 3 of the Broadband Connect Guidelines for further guidance.
3. Are you or your organisation applying for a second Broadband Connect Service at the
   ‘Broadband Connect Service Address’ nominated above, due to the entitlement of a
   Residential Customer to an additional Broadband Connect Service at the same Premises,
   subject to meeting other eligibility requirements?
                                                                            Answer: YES / NO
4. Have you or your organisation previously received a HiBIS or Broadband Connect Service at
   the ‘Broadband Connect Service Address’ nominated above?
                                                                           Answer: YES / NO
If YES, provide:
the name of the previous Service Provider:....................................................................
the reason for terminating the service: ...........................................................................
                         ..........................................................................................................
Note, a second Broadband Connect Service may also be provided to a Broadband Connect Premises where a HiBIS or
Broadband Connect Customer moves to that Premises and the HiBIS or Broadband Connect Service supplied to that
Premises previously may no longer be supplied because of circumstances beyond the control of the customer. For example,
the previous HiBIS or Broadband Connect Customer at the address removed the satellite dish or wireless antenna when
vacating the Premises.
5. To the best of your knowledge, has the Broadband Connect Premises nominated above been
   previously supplied with a HiBIS or Broadband Connect service but is no longer able to
   receive that HiBIS or Broadband Connect service?
                                                                              Answer: YES / NO
If YES, provide:
the name of the previous Service Provider:....................................................................
the reason for the previous Service not being able to be supplied to the address: .........
                         ..........................................................................................................
                                                                      Page 2 of 3
Form 1: Broadband Connect Customer Attestation Form

ISDN services not available at the premises due to technological limitations
The availability of ISDN at particular premises determines whether a High Cost Incentive Payment or a Standard Incentive
Payment applies for the Connection and Supply of a Service to the premises. While the telephone exchange may have been
ISDN-enabled, premises connected to that exchange may not be ISDN capable due to technological limitations, such as the
use of network electronics, eg Pair Gains or due to distance from the exchange.
6. Have you enquired of Telstra whether ISDN is available at your premises, in order to
   determine whether to request this service?
                                                                              Answer: YES / NO
7. Were you advised that ISDN is available or not available?
                                                       Answer: AVAILABLE / NOT AVAILABLE
8. How did you hear about Broadband Connect?
      Contact by Service Provider
      Australian Government promotional material (i.e. posters, radio, TV, Internet, newspapers etc)
      State/Local Government and/or community/industry organisations
      Other      - Please provide details:
                       ..........................................................................................................

Section 4:                  Attestation
I attest that, to the best of my knowledge:
•   the personal information I have provided is true and accurate; and
•   I, and the premises at which I require the Broadband Connect Service, are eligible under the Scheme and I have made
    such inquiries as are reasonable to confirm this.
I agree to:
•   DCITA making inquiries as necessary with any organisation or individual to verify any information I have provided;
•   my service provider making available to DCITA any information concerning my application and participation in
    Broadband Connect; and
•   DCITA, as well as other Government agencies and/or my service provider using my personal information for the
    purposes of Broadband Connect program administration, evaluation, related policy development and other related
    functions.
I understand that:
•   I may be required to provide documents to substantiate my attestation;
•   I may be asked to participate in Broadband Connect evaluation activities; and
•   it is a criminal offence under the Crimes Act 1914 to deliberately make false or misleading statements.


Signed by the customer:                 ……………………………………                                              Date: .…/…./….

Printed name:                           …………………….………………

Office Use Only
Name of service:
Incentive Rate:                                        Telephone of Premises:
Reason why customer eligible:
Travel claim (if applicable):
Depot departed from:                                   Distance Travelled:
Date service requested:                                Date of connection:
Date of claim:                                         Broadband Connect Customer ID number:




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