APPLICATION FORM FOR CELLPHONE CONTRACT

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APPLICATION FORM FOR CELLPHONE CONTRACT Powered By Docstoc
					Mobile Banking Services (Pty) Ltd
T/A OKRA Cellular
Reg. No. 1007/015877/07
                                                                 APPLICATION FORM FOR
Unit 9, Suite 4, Tygervalley Office Park                         CELLPHONE CONTRACT
Silverlakes Road, Pretoria

                                                                   To be completed by Dealer
Dealer name:                                                                              Agent name

Under Administration?                             (Yes/No)       Debt Counselling?               (Yes/No)             Contract Number
MSISDN Number                                                                             Other Products
Delivery Address of Dealer                                                                                                                                        NEW
                                                                                                                                                                 Upgrade
                                                                          Subscriber Details
                             Note to Subscriber: Please complete accurately in black ink and provide all documentation to speed up process.
 Mr             Mrs            Miss              First Names
          Surname                                                                                      ID No

Date of Birth                                           Marital Status                                 Gender                        SA Citizen
Physical Address

Period at above address                                 Years                  Months
Delivery Address
Postal Address
Home Tel                                                            Fax                                                 Work Tel

E-mail                                                                                                 Residential Status                          (Owner/Tenant)

                                                                Next of kin (Not living with you)
Name                                                                       Surname                                                          Relation
Employer
Date of Birth                                                              Home tel                                            Work tel
Cellno                                                                            Secondary Cell Nr.

                                                                          Employment Details
Name of Employer                                                                                Contact Person
Payroll office                                                                                  HR Tel no.
Physical Business Address (Head Office)


Physical Business Address (Employee)
Floor Nr.                                  Office Nr.                                   Supervisor Name:
Employee Telno                                                                          Supervisor Telno:
Occupation                                                                                      Employee Nr.
Salary after deductions                    R                                   Commencement Date                                     Salary Date
Type of Employment                                              (Permanent/Contract)      Payment Frequency                                  (Monthly,Weekly,Bi-weekly)

                                                         Authority for Debit Order - Compulsary
         Account holder name:                                                                             Account number:
                       Bank name:                                                                              Branch Name:
                     Branch Code:                                                                              Account type:
                                                                                                                               (Savings, Transmission, Cheque, Other)
 I hereby instruct and authorise Okra Cellular (Pty) Ltd or hteir nominee to draw against my/our account with abovementioned bank with all ammounts becoming due and
                        payable by me/us pursuant to the acceptance of this application and hereby warrant that I/we are the authorized signatures




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                                                                                                        Service Info
Once off payments
                                                                                                                           Monthly Tariffs
Sim and Connection Fee                                R                                                                    VAS                                              R
Delivery                                              R                                                                    Handset Make and Model                           R
Other Once-off payments                               R                                                                    Monthly Tariff                                   R
Upgrade                                               R                                                                    Total Monthly Tariff                             R        0
Total Once-off payments                               R         0

Declaration

I/we the undersigned hereby warrant that the detail supplied are true and correct. I/we hereby also declare that I’we have read and understood the standard terms and conditions overleaf, should the application be
approved
I/we hereby abide by the said conditions.                                       Signature                                                                           Date

Declaration
   1     All the information in this is true and correct, I comply with the qualifying criteria and I’m in the position to afford and pay the implied costs.
   2     I have not been sequestrated in the last 10 years, not have I reached any compromise with my creditors.
   3     I am a permanent resident of South Africa.
   4     I specifically authorize Okra Cellular to access any information available to assess this application, and also give Okra Cellular permission to register details of my conduct in respect of my account with any credit
         bureau or any third party, and waive any claim that I may have against Okra Cellular in respect of such disclosures.
   5     I am fully aware of the terms and conditions of this application, which can also be obtained from www.blue.co.za
   6     Okra Cellular is free to decline or approve this application for any reason whatsoever
   7

         I grant the debit order instruction as referred to above, and realise that Okra Cellular relies on this debit order instruction as a condition of the product and services to me, without which I do not qualify.
   8     I confirm that, should Okra Cellular approve this application together with all Annexures and Schedules thereto, it constitutes a binding agreement and,
   9     I further confirm that I have read and understood the Okra Cellular Terms and Conditions, and specifically acknowledge that said Terms and Conditions are binding to me.

        Signed at                                                       on this date:

       Signatures:           1                                                                                        2

Debit order authorisation, including mandate authority for payment instruction by payer
Name of account holder
Name of current bank on issue of this authorisation
Branch Number                                                                                                              Account Number
Type of Account (Current/Cheque, Savings, Transmission)
Salary payment date:                                                                                                       Date of first payment:
The current beneficiary who must receive the payment is..

I, the undersigned whose particulars are contained herein, hereby issue instruction and order my current or future bank to pay, on receipt of such requests using whatever manner, the payments indicated in this
agreement, by debiting my bank account. The debit order payment stream will be used to effectuate my indebtedness in terms of this mandate.
My first payment instruction can be delivered to for payment to my bank to correspond with the date specified in this agreement. I understand and agree that subsequent payment requests will continue to be delivered to
my bank and bank account reflected herein, in which instance I will notify the beneficiary specified, or any new beneficiary should the agreement be ceded to a third party. Should I however forget to notify the beneficiary or
the assigned third party, or if Okra Cellular or the assigned third party obtain my new bank account on own account, this mandate issued will not lapse, but will cover such new banking information obtained and Okra
Cellular and the assigned third party may attach such new information to this signed document as Annexure. The Annexure attached must be read together with this mandate by my new bank. I agree and understand that,
although this authority and mandate may be cancelled, such cancellation will not cancel this agreement. I understand that I cannot reclaim payments made and received from my bank whilst such amount are still legally
owed to the beneficiary recorded or the newly assigned beneficiary. It is agreed that due of the product(s) and serivces acquired, this mandate shall endure for an indefinite period, up until the services is formally
terminated by me in terms of the Okra Cellular Terms and Conditions. I have read, understood and accepted the applicable Okra Cellular Terms and Conditions.

Account Holder Signature


Print Name of Account Holder:…

   1     Communication and Marketing
  1.1    Okra Cellular continually strives to provide the best bundle of products and services to suit your new and evolving needs. We would liketo be able to inform you of exciting new products and special offers, so that
         you can make the best choices regarding your financial needs. Would you like to be informed? YES/NO
   2     Okra Cellular sometimes partners with other organisations in an attempt to arrange exclusive deals for our clients’ benefit. We would like our partners to present these to you, so that you don’t miss out on
         amazing opportunities that could be relevant to your evolving needs. Would you like us to ensure that these opportunities are presented to you? YES/NO
   3     Okra Cellular aims for product and service excellence. However, your valued opinion is needed in order for us to achieve this goal. We contract reputable research organisations to convert our clients’ input into
         relevant suggestions for improvement. Would you like to voice your opinion? YES/NO
   4     Okra Cellular wishes to use your identity, photgraph, video image and / or life story for marketing purposes, including but not limited to to advertising in any form of media desired by Okra Cellular. You agree that
         your participation in such is done voluntarily, and you shale receive no compensation. You agree you will not prosecute or institute legal proceedings, claims or demands against Okra Cellular in respect of any
         usgae of the above, or implied association between you and Okra Cellular, whether it is now or in the future. You agree that Okra Cellular shall have unrestricted use of the above, either separately or together,
         Please tick which channels you would prefer us to use when communicating the above to you

              All                   E-mail                SMS                      Direct Mail                        Telephone                       Other




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Subscriber Agreement:
   1     Definitions

         In this agreement, unless the contract clearly indicates, the words herein below defined shale have the meaning assigned to them and similar expressions shall bear corresponding meanings.
 1.1.    “Activation” means the enabling of a SIM card to operate on any of the national cell phone networks, subject to the terms and conditions of this agreement.
 1.2.    “Agreement” means the application form and these terms and conditions.
 1.3.    “Blacklist” means the disablement by electronic or other means, of the Subscriber’s handset, thereby preventing further use of the handset entirely.
         “Charges” means the connection charges, moonthly service fees, deactivation, reactivation and suspension pertaining to the provision of the network services, SIM card(s) and any otherservices howsoever
 1.4.    described by Okra Cellular to the Subscriber from time to time.
 1.5.    “Equipment” means a GSM terminal phone device and accessories thereto, utilised by the Subscriber to send or receive a point-to-point delivery of signals carrying sound or data.
          “Greylist” means the flagging of the Subscriber’s handset on the network to identify the active mobile number in use by the handset operator, in order to facilitate the possible tracing, locating and recovering of
 1.6.    the handset by the Subscriber. (eg. In the event of theft of the handset)
 1.7.    “Initial period” means a period of 24 (twenty four) successive months commencing from the date of activation which date shall be set out in the first statement sent to the Subscriber.
 1.8.    “Insurance charges” means the premium payable for the insurance of the equipment against risk of loss or damage.
 1.9.    “Interest rate” means the prime interest rate from time to time plus 2%.
 1.10. “Migration” means the ability to change the type of tariff plan applicable to the Subscriber’s contract.
 1.11. “Month” means a calender month.
 1.12. “Monthly service charge” means the monthly charge levied by Okra Cellular with regards to the Subscriber’s access to and the use of the network services.
 1.13. “Okra Cellular premises” means the offices of Okra Cellular as set out in the application.
 1.14.   “MSISDN” means the Mobile Station International Subscriber Directory Number (otherwise know as the mobile telephone number programmed into each SIM card.
        “Network Services” means the mobile telephone services provided by any of the national cell phone providers’ networks including , inter alia, SMS card(s) and other services that Okra Cellular may determine
 1.15. from time to time.
 1.16. “Order” means the application form or in any other form approved by Okra Cellular for the provision and/or installation on terminal equipment, SIM card(s) and/or use of the network services.
        “Package option” means any of the tariff plans under which the network services are made accessible to Subscrivers. May vary according to the rate of usage charges, value-added services included and other
 1.17. vaiables determined by Okra Cellular or the network operator from time to time.
 1.18.  “Price list” means the schedule on which the charges levied are recorded from time to time.
        “Renewal Period” means means the transaction, effected at the expiry of the Initial Period, and therefore the simultaneousrenewal of this agreement by the Subscriber, for a period equal to the Initial Period and
 1.19. in accordance with the applicable le level and model of handset, as determined by Okra Cellular in its sole discretion from time to time.
 1.20. “SIM card” means a Subscriber Identity Module which, when activated, provides a Subscriber using compatible equipment, with access to the network services.
 1.21. “Subscriber” means that party whose particulars appears on the application form.
 1.22. “Subscription fee” means the monthly fee payable by the Subscriber in respect of access to the Network by means of the Subscriber Number.
        “Upgrade” means means the transaction, effected at the expiry of the Initial Period, and therefore the simultaneousrenewal of this agreement by the Subscriber, for a period equal to the Initial Period and in terms
 1.23. of which Okra Cellular may supply to the Subscriber a new Cellular Phone against payment of relevant charges.
 1.24. “Usage charges” means the charges to the Subscriber for recorded usage on the Network services from time to time.
 1.25. “Value-added services” (VAS) means the secondar services designated as such and which may be provided only to Subscribers under certain package options.
   2     Commencment and Termination
 2.1.    This agreement shal commence on the date of activation of a SIM card issued to the Subscriber by Okra Cellular and shall be subject to the provisions of clause 5 and, continue for the Initial Period, and thereafter
         continue on a month to month basis, unless renewed in accordance with the Renewal Period.
 2.2.    One calender month’s written notice is required should the Subscriber wish to cancel the contract after the Initial Period, provided that the Subscriber has not commenced a Renewal Period as a result of a
         handset upgrade or similar reason.
 2.3.    In the event of and after direct marketing only, the Subscriber shall be allowed to cancel this application within 5 (five) days of signing this application, provided that goods so returned shall be done within 10 (ten)
         business days and at the sole risk and expense of the Subscriber, meaning that if the Subscriber opened the original packaging or used the equipment, hê shal be laible for the reasonable amount for restoration
         cost.subscriber shall be allowed to within 7 (seven) business days from delivery, return the equioment in the event that it should be unsafe or defective
         The
  3.     Supply of SIM cards, installation and network services
 3.1.    The approval of his aplication by the Subscriber is to OKRA Cellular’s sole discretion.
 3.2.    All risk of loss or damage in and to SIM cards supplied and delivered to the Subscriber shall pass to the Subscriber on delivery.
 3.3.    If a SIM card is lost, stolen or damaged, OKRA Cellular may in its discretion require the Subscriber to effect payment of a reasonable charge in respect of the cost issuing a replacement.
 3.4.    The subscriber hereby warrants that:
 3.4.1 The equipment shall not be used or allowed to be used for any unlawful purpose, nor in any way which may cause injury or damage to persons or property or an impairment to the Network service,
 3.4.2 Any third party shall be allowed to reverse engineer, decompile, modify or tamper with the software, the MSISDM or the ICC contianed in, or pertianing to any SIM card.
  3.5    Where the Subscriber subscribes to a package option that includes provision of value-added services free of charge, the network operator shall be entitled, in tis sole discretion, tovary, discontinue or substitute any such value-adde
   4     Charges
 4.1.    In consideration for the provision of the network services, insurance and any other services supplied, the Subscriber shall be laible for any monthly or other fees as contracted whether or not the network services
         have been, or are being utilized by the Subscriber.
 4.2.    All charges are subject to change from the network provider and their price list from time to time.
 4.3.    In the event that payment for the services provided is made by debit order, the Subscriber will commit a breach of this agreement if the Subscriber:
 4.3.1 Cancels such debit order without the written consent of OKRA Cellular.
 4.3.2 Does not have sufficient funds to service debit order on due date, the Subscriber hereby authorizes OKRA Cellular to debit the bank account as identified by the Subscriber from time to time for the charges owed
       by the Subscriber to OKRA Cellular in terms of this agreement.
 4.4.    The subscriber agrees and is aware of the fact that all debit orders shall be done and sanctioned on the salary due date as indicated. In the event that the salary due date of the Subscriber could change, the
         Subscriber undertake to inform OKRA Cellular of such change in order to ensure that no additional cost is incurred.
 4.5.    In the event that the Subscriber’s salary due date falls on a Saturday, Sunday or public holiday, OKRA Cellular reserves the right to submit the debit order to be sanctioned on the day prior or directly thereafter
 4.6.    The monthly statement shall be sent by OKRA Cellular to the Subscriber on request, in arrears to the address selected in Section A. It shall be the responsibility of the Subscriber to check the statement in order
         to ensure that the contents therefo are correct.Unless a query is raised in respect of the contents of a statement within 30 (thirty) days from the date thereof, the contents thereof shall be deemed to be correct.
 4.7.    The Subscriber shall make good to OKRA Cellular for all other charges relating to any other services (VAS), incurred in respect of the services and/or any cellular phone or other equipment purchased / activated
         by the Subscriber from Vodacom within 14 (fourteen) days of fate of OKRA Cellular’s statement. The Subscriber will remain responsible for the monthly payment of said services for the term that the services are
         active with Vodacom. If the Subscriber wishes to cancel said services with Vodacom the responsibility lies with the Subscriber to notify OKRA Cellular of such camcellation in writing.
 4.8.    Interest in all overdue accounts will be charged at prime plus 2%.



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  4.9.   Any migration from one package option to another shall for the duration of this agreement be subject to levy fees for migrations.
 4.10. Where the package option includes free (inclusive) minutes:
 4.10.1 No usage charges will be payable for the inclusive minutes.
 4.10.2 Inclusive must be used during a period of a month prescribed and cannot be accumulated.
 4.10.3 Where the Subscriber subscribes to a package option, with weekend between 20h00 Friday to 08h00 Monday.
 4.10.4 Inclusive minutes where they are applicable to a package option, shall be limited to local and national mobile calls, within South Africa (as defined below) as well as calls to the value-added services to which the
        Subscriber may have free subscription from time to time.
4.10.4.1 A local call is a call made to destinations within the Republic of South Africa, less than 400 (four hunderd) kilometers away from the originator of the call.
4.10.4.2 A national call is a call made to a destination within the Republic of South Africa equal to or greater than 400 (four hunderd) kilometers away from the originator of the call.
4.10.4.3 A mobile call is a call within the Republic of South Africa, from one terminal equipment to another where both are connected to a PLMN (Public Land Mobile Network)
 4.11. Local, national and inclusive minutes are calculated and charged in units of 60 for the first, and 30 second units thereafter, (unless the Subscriber is on a per second billing price plan). In the event that the
       Subscriber uses any part of a unit, the Subscriber shal be liable for the full charge in respect of that unit.
   5   Suspension
  5.1.   OKRA Cellular can at any time, and without notice to the Subscriber and in any manner whatsoever provided by the network service, suspend the Subscriber connection if:
 5.1.1 Any modification, maintenance or remedial work is required to be undertakne pertaining, to the network services
 5.1.2 The Subscriber fails to perform any of his obligations, or breeches any term of this agreement.
  5.2.   In the event that the Subscriber’s access to the network service is suspended, the Subscriber shall still be liable for the monthly service charges during any such period of suspension.
   6.    Limitation of liability
         Without detracting from any of the provisions of this agreement, OKRA Cellular shall not be liable to the Subscriber for any loss or damage suffered by the Subscriber and whether same is direct or consequential
  6.1.   to the: supply and/or deliver and/or installation of any equipment or SIM card(s)
         Latest
  6.2.   Network services being interrupted, suspended or terminated, for whatsoever reason.
  7.0    Breach
  7.1.   In the event that the Subscriber breaches any terms of the agreement, or fails to fulfill any obligation resting upon the Subscriber, includinga falure to pay any amount owed to Mobile on due date, then without
         prejudice to its rights in terms of this agreement of the common law, OKRA Cellular may forthwith and without notice to the Subscriber either terminate this agreement or call for specific performance of all the
         Subscriber’s obligations and immediate payment of all sums of money owed by the Subscriber.
  7.2.   OKRA Cellular shall be entitled forthwith without notice to terminate this agreement in the event that the Subscriber is provisionally of finally and voluntarily or compulsary sequestrated
    8    Insurance
  8.1.   Unless the Subscriber specificially elects to take insurance on the equipment and related risks, the Subscriber shall not be covered in respect of the loss or damage of the equipment and related risks.Iti shall be
         the responsibility of the Subscriber to obtain and familiarize himself with the terms and conditions of the insurance policy applicable.
  8.2.   It shall be the responsibility of the Subscriber to ensure the premiums in respect of the insurance policy are paid tinely in full
    9    General
  9.1.   All prices and charges set out in this agreement are exclusive of value-added tax (VAT)
  9.2.   The rights and obligations of the Subscriber in terms of this agreement may ot be ceded or delegated to any third party. The rights and obligations of OKRA Cellular in terms of this agreement may be ceded and
         delegated by it to any other party without written notice to the Subscriber.
  9.3.   The terms and conditions of this agreement are subject to the terms and conditions of the license issued to the network operator.
  9.4.   This document contains the entire agreement between the parties regarding the matters contained herein and no other warranties, undertakings and/or representations have been made to the Subscriber.
  9.5.   No indulgence or extensions (of time) shall in any way prelude OKRA Cellular from exercising any of its rights in the future.
  9.6.   This agreement and all matters and disputes arising there from incidental therfore shal be governed and construed in accordance with the law of the Republic of South Africa.
  9.7.   If any term, condition, agreement, or provision contained in this agreement is held by any court having jurisdiction to be enforceable, illegal, void or contrary to public interest, such term, condition pr provision shal
         be regarded as being divisible from the remainder of the agreement.
  9.8.   The Subscriber hereby authorizes OKRA Cellular o disclose the Subscriber’s personal details to any other party, whenever it is reasonably necessary for OKRA Cellular to properly perform its function or to
         protect its interest of for the purpose of enabling emergency network services repair services and information to network users generally.
  9.9. The Subscriber hereby authorizes OKRA Cellular to use his personal information to make a decision as to whether or not to approve this application. It is therefore understoof that the information provided must be
       true and correct and should this not be so, the Subscriber will be in breach of this agreement. By signature hereof, the Subscriber grants OKRA Cellular permission to contact any person or to access any
       information available, including that which relates to his financial status, credit record and payment history in order to assess his application and to confirm the personal detail supplied by him and further to
       register details of his account with a registered statutory register and/or credit bureau.
 9.10. In the event that the Subscriber’s agreement reaches legal status, OKRA Cellular reserves the right to blacklist the Subscriber’s handset, and the Subscriber shall have no claim against OKRA Cellular arising
       from the exercising of this right by OKRA Cellular.
 9.11. When a Subscriber’s account with OKRA Cellular is restored and all monies so owing to OKRA Cellular has been recovered from the Subscriber, OKRA Cellular shall within 14 (fourteen) days, remove such
       blacklisting.
 9.12. All notices, documents or letters sent by the Subscriber or OKRA Cellular concerning this agreement must be sent to the address of the party so chosen,. For this purpose the Subscriber chooses the address as
       supplied to OKRA Cellular by him in Section A as part of his personal particulars and acknowledge that correspondence can be delivered to OKRA Cellular at P.O. Box 72041, Lynnwood Ridge, Pretoria, 0040,
       RSA. Any party may change these addresses by written notice.
 9.13. Each of the parties shall be entitled from time to time, by written notice to the other vary its domicile to any other address within the Republic of South Africa which is not a post office box or poste restante

 9.14. No alteration, cancellation or variation of this agreement shall be of any force or effect unless OKRA Cellular has given its written consent.
 9.15. Where in terms of this agreement any communication is required to be in writing, the writing shall include communication by telex and/ior facsimilee.
 9.16. In the event of OKRA Cellular taking any legal steps arising out of this agreement, the Subscriber shall be liable for legal costs on the scale as between attorneys and client and/or any collection costs including
       tracing fees and collection commission.
 9.17. Notwithstanding the foregoing the Subscriber will be liable for any and all bank charges incurred by OKRA Cellular and/or himself, due to non-payment or any debit order, reversed and/or cacncelled cheque
       and/or any dishonored payment due to insufficient funds in his bank account on the salary due date, including administration charges for the processing thereof by OKRA Cellular




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  10.    Equipment
 10.1.
         Ownership in and to equipment supplied and delivered by OKRA Cellular to the Subscriber is reserved until payment of all amounts payable to OKRA Cellular In respect of this agreement has been effected in full.
 10.2. All risks in and to equipment supplied shal vest in the Subscriber from date of delivery.
 10.3. OKRA Cellular’s obligation in terms of any warranties pertaining to the equipment shall be limited to the warranty provided by the manufacturer of the equipment.
 10.4. Should the Subscriber, upon receiving of the equipment, discover any fault or defect in the equipment, the equipment should be promptly returned to the service outlet in the same condition and packaging that it
       was received. Prevailing Out of Box Failure warranty conditions shall apply“
 10.5. Any equipment and colors thereof shall be subject to availability.
 10.6. In the event of theft or loss of a handset by the Subscriber, he will be entitled to request OKRA Cellular, on receipt of all requested and required information by OKRA Cellular, to list such handset on the Network,
       on the Grey List, or Black List as determined by OKRA Cellular, prevailing policy at the time of loss or theft
  11.    Liquidated damages
 11.1. In the event of early termination of this agreement for whatsoever reason by the Subscriber, other than death, OKRA Cellular shall have the right to claim from the Subscriber an amount equivalent to the value of
       this agreement.
 11.2. In the event of OKRA Cellular terminating this agreement due to breach by the Subscriber, the balance amount owed in terms of this agreement will be regarded as liquidated damages.
 11.3. A certificate issued by a manager of OKRA Cellular confirming the outstanding balance will be regarded as prima facie proof of any amount outstanding from time to time

CODE

Subscriber's Signature                                                                                               Subscriber's Current contact number




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