12345791011121314151617181920Personal InformationLAST NAMEFIRST NAMEMIDDLE NAMEMOTHER'S FULL MAIDEN NAME (First, Middle, Last)BIRTHDAY (mm/dd/yyyy)CONTACT NUMBEREMAIL ADDRESSService InformationMobility SolutionsTAX IDENTIFICATION NUMBER*Statement of Account/bill will automatically be E-mailed to this address.SERVICE TYPEPLAN NAMEADD ONS (Inclusions)15PRIMERS1MOBILESPECIAL FEATURES (Tick to deactivate)INTERNATIONAL ROAMINGGADGET INFORMATION (Gadget brand)6 MONTTHS ( LINE ONLY )262TATTOOIDD373GENDERMALEEmployment/Financial InformationEMPLOYER BUSINESS NAMEINDUSTRYMANUFACTURING FOODMANUFACTURING NON FOODSEMICONDISTRIBUTIONLOGISTICS AND TRANSPORTEDUCATIONRETAILHEALTHCARE SERVICESGOVERNMENTBARANGAY MUNICIPALITY TOWNCITY PROVINCEMOBILE DATAMONTHLY SERVICE FEE (MSF)GADGET MODEL24 MONTHS ( WITH HANDSET)484FEMALECOMPLETE BUSINESS ADDRESS (Unit/Floor/Building Name/Street No./Street Name)OFFICE PHONE NUMBERJOB LEVELRANK AND FILESUPERVISOR/TEAM LEADERMANAGER/ASST. MANAGER68BPOFINANCIAL INSTITUTIONREAL ESTATE AND CONSTRUCTIONPOWER AND UTILITIESPETROLEUMITMEDIAHOSPITALITYOTHERS (Please specify) _____________AVP/SVP DIRECTORC - LEVELPOSTAL CODE ZIP CODE_______________EMPLOYMENT STATUSREGULARPROBATIONARYOTHERS __________________________OTHERS _____________________Service Application Form for Corporate IndividualEmployee CertificationThis document is to certify that the undersigned employee, is a regularemployee (“Employee”) of _________________ (“Company”) receiving amonthly salary of Php__________ and monthly communication allowanceworth Php___________ to cover the telecommunication expenses for officialbusiness, hence, all benefits and privileges accorded by Globe Telecom, Inc.(“Globe”) to Company for mobile telecommunication subscriptions may beextended to the Employee. Said benefits and privileges, however, will be madeavailable to the Employee on condition that he/ she remains an employee ofthe Company. In the event of resignation, retirement or termination ofemployment of the Employee, Company shall immediately inform Globe inwriting of such fact and Globe may withdraw the benefits and privilegesextended to the Employee.It is understood that the Employee shall be solely responsible for theobligations arising from his/her respective subscription to Globe mobiletelecommunication services._________________________________________________Name & Signature of HR Authorized Signatory_________________________________________ /________________________E-mail Address & Mobile Number of Authorized HR RepresentativeSubscriber's Declaration_______________________________Company Name______________DateI/We hereby confirm that the foregoing information is true and correct,and that the supporting documents attached hereto are genuine andauthentic and voluntarily submitted by the subscriber for the purpose ofan application for a Globe mobile service.I/We the authorized representative/s of the company hereby authorizeGLOBE TELECOM to obtain pertinent credit information from banks,credit card companies, and other financial institution on the courseof credit investigation of the company's application, and I/We herebyauthorize the release of such information by the bank, credit card, andfinancial institutions from which credit information is requested.I/We hereby confirm that I/We have read and understood the Terms andConditions stated on the reverse side of this form and that the companyshall comply with them and with any additional terms and conditions inany certificate required to be executed in connection with any particularGLOBE TELECOM promotions or plans.I/We acknowledge and agree to the minimum subscription period to therelevant Service availed of. If I choose to downgrade my plan, transferany rights or obligations of my subscription or terminate or cancel mysubscription within the minimum subscription period then I agree to paythe relevant fees and penalties.I/We am aware of the fees, rates and charges relevant to theService availed of and I agree to pay the same within the due dates.I understand that I will be subject to interest and penalties forlate payment or non-payment stated in the Terms and Conditions.I/We agree that this Subscription Agreement shall govern our relationshipfor the service currently availed of and service I will avail of in the future.SALES BLITZI/We consent to the company’s disclosure of information concerningmyself/ourselves or my/our subscription to financial institutions, creditbureaus or similar organizations.I/We hereby confirm that any device issued by GLOBE TELECOM is my fullresponsibility. The damage to or loss of device is not a valid ground notto pay the MSF and other charges. GLOBE TELECOM has no obligation torepair or replace a damaged device outside the manufacturer’s warranty.Corporate IndividualName and Signature of Subscriber________ ________ ________ ________ ________ ________ ________ ________ ________ __Date____ ________ ________ ________For Globe Telecom's Use OnlyI have checked and verified the supporting credit requirements against theoriginal documents and found them to be authentic and in accordance inaccordance with GLOBE TELECOM requirements.ACCOUNT MANAGER NAME IDDATESIGNATUREBY SUBMITTING THIS FORM, I CERTIFY THAT ALL THE ABOVE INFORMATION IS ACCURATE, AND I AGREE TO THE TERMS AND CONDITIONS OF THIS SERVICE.
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