OSN Pinoy Plus OSN Pinoy Plus Extra Firstnet Premium Firstnet Basic Pehla Silver Pehla Gold

OSN Platinum Plus HD OSN Premier Plus HD OSN Premier Lite OSN Entertainment OSN Entertainment Lite

More than 60 startup channels for Free in addition to 16 a la carte channels which you can subscribe to directly from your eLife TV Box.

Welcome to Etisalat

application formeLife

Serial No.:

Dece

mbe

r 201

3

For official use only

A/c No.:

Sales Person Name:

Reseller Code:

Salesman Code: Contact No.:

*Name of applicant Mr./Mrs./Ms.:

C/O: *Emirate: *Nationality:

*Mobile (1): Mobile (2):*ID Type: *ID No.: Expiry (dd/mm/yyyy):

*P. O. Box:

Building: Floor: Flat No.: Area:

City: Sector: *Working landline number in the same building:

Plot: Etisalat EID (located on ground floor entrance): Existing number in your name:

Transfer Subscriber Name:

Location

Personal details

*Mandatory

New Customer Upgrade/Modify

Gateway/Router: Purchase Purchase

1 month

Call Barring Pin:

List name in telephone directory

Free calling card Serial number:

Safe custody: From: To:2 months

1 fils/second international calls

Speed Mbps: 1 10 20 50 300100 500

Norton Internet security subscription

Internet username: First choice: Second choice: Third choice:

Unlimited Internet Free, 5GB storage capacity email boxes, 8 hrs/month public Wi-Fi hotspot

Internet

eLife Mini Packages: Arabia Family Lifestyle Apna My Pinoy

Choice Basic: Arabic Asian Western Filipino

Advanced Star Package

Telephone

eLife Triple Play (TV + Internet + Telephone)

e-Bill Bill statement language: Arabic English

Shifting or other External shifting

eLife TV Box swap

Additional socket:

eLife password recovery:

TV Internet Telephone Customer signature: Date:

Your authorisationI/We hereby confirm to Etisalat that I/We have the authority and/or permission to install the Etisalat Service in the abovementioned address and hereby agree.

Sports: Al Jazeera Sport Abu Dhabi Sport A la Carte:

High Definition: High Definition Recorder:eLife TV Boxes:TV

eLife Single Play (TV only or Internet only)eLife Double Play (Internet + Telephone)

eLife ON: Video Packs:

Wi-Fi extenders:12 months 24 months

Purchase 12 months 24 months

Telephone device: Purchase 12 months 24 months

Wireless Video Bridge:

Technician visit

Other

*Email:

Request number: Serial number: Card number: