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1800 266 4986
www.expl.in CUSTOMER APPLICATION FORM
[email protected] (Please fill the form in block letters only)

Order Reference Number:

1. Name of the Customer / Entity

First Name Middle Name Surname

2. Father’s / Husband Name

Date of Birth M F Others

Nationality Sex
3. Address (with proper landmark)

Pin Code
4. From where did you hear about us?
Social Media ☐ Website ☐ Google ☐ Referred by a Friend/Relative ☐ Banner ☐ Radio ☐ TV ☐
Others: ____________________
Kindly mention User ID / contact no. of the person who referred you to us: ____________________________

5. Document proof (Attach photo copies of address proof and photo ID)
a. Address proof: Adhar Card No.: ______________________ Driving License No.: ____________________________
Passport No.: _______________ Pan Card No.: __________________ Elect. Bill No.: _________________________
b. Photo ID: Adhar Card No.: ______________________ Driving License No.: ____________________________
Passport No.: _______________ Pan Card No.: __________________ Elect. Bill No.: _________________________
6. Contact Details:
Primary: Alternate No.:
Broadband  SME  Corporate 
7. Email ID: ______________________________________
8. User ID: _______________________________________ GST No. ______________________________________

TO BE FILLED BY SALES EXECUTIVE

A) Installation (Cash/ UPI/ Cheque / NEFT) ₹ Reference / receipt no.:
B) Plan (Cash/ UPI / Cheque / NEFT) ₹
C) Landline(Cash/ UPI / Cheque / NEFT) ₹ Reference / receipt no.:
D) Modem / Modem cum Router Reference / receipt no.:
₹
(Cash/ UPI/ Cheque / NEFT)
Total ₹ PAID (A + B + C + D) ☐

Estimated Date of Installation: Date of Payment:

Suraksha Patekar (+919322921267)

Name & Signature of the Executive Date:
I understand that this payment is being collected for and on behalf of the Business Associate mentioned above. I have read and
hereby agree to the Terms and Conditions of ETHERNET XPRESS.

_______________
Signature of Subscriber Date:

Head office: Near Mango Tree Rest. Beach Rd, Vagator, Goa – 403509.
Branch Office: Bldg-S2, Office No. 201, Nova Cidade Complex 2nd Floor, Porvorim, Bardez, Goa – 403521.
Branch Office (Margao): Shop #A - 312, 3rd floor Block-A, Reliance Trade Centre, Varde Valaulikar Road, Salcete, Margao, Goa.
Branch Office (Vasco): Shop No. 8, Anand Chambers, FI Gomes Rd, New Vaddem, Vasco da Gama, Goa 403802.
ForthelatestTermsandConditions,PlansandPoliciesvisit: www.expl.in
 TERMS & CONDITIONS
GENERAL:
1. Subject to the acceptance of the application and technical feasibility Ethernet Xpress India Pvt. Ltd. (EXPL) will endeavour to provide the
Broadband service at the earliest.
2. In order to subscribe to EXPL one must be 18 (eighteen) years of age or older and must provide valid documents as requested.
3. Devices and Installation Charges are NON refundable / NON transferable. Installation charges includes: Activation Fee + Installation cost Fee.
4. Plan amount is NON refundable / NON transferable to any other account.
5. EXPL does not hold responsibility for lesser Download / Upload data rates caused by the accessed website status, the internat ional gateway or
the media.
6. The Residential Broadband connection is likely to be withdrawn in case the customer surrenders the Broadband connection.
7. If a connection is taken during an offer period and devices are provided free of cost, then the devices will be the sole prop erty of EXPL & the
device must be returned back at the time of termination of service in working condition. Fiber cable used for a connection remains as the sole
property of EXPL.
8. Modem / Modem + Router comes with 1 year warranty from date of installation no matter how many replacements are made during t he
warranty period.
9. Warranty will be treated null & void if product is physically damaged, water damaged, burnt, broken by natural disaster, or use which is different
from the EXPL advice and instructions.
10. EXPL will only be able to replace defective product with a same model or an equivalent product. No option of upgrading to or substituting
different products. The maximum liability of EXPL is equal to, and no higher than the products purchased price.
11. Please retain the invoice or receipt to verify the purchase for any warranty claim. EXPL may decline to offer warranty service if the effective
invoice or receipt is failed to be produced.
12. Power Supply, LAN, WiFi Router, Extenders and internal fittings of cables and wiring to be taken care by the customer.
13. EXPL will provide service till our devices (Landline handset, Modem / Modem + WiFi Router) whichever are mentioned in application form and
will NOT be responsible for any additional purchase (LAN, Routers, Extender, etc.) from EXPL employees / third party.
14. Shifting of a Residential Broadband connection is subjected to the technical feasibility. If feasible, shifting of connection will initiate after the
payment of shifting charges. If existing device (Landline, Modem / Modem + WiFi Router) doesn’t support at place of shifting, then, device
replacement charges are applicable.
15. If devices are provided free of cost and does NOT support at place of shifting, the devices must be returned back in working condition with the
power adapter.
16. Conditions for providing Home / Business Plan.
a. A Residential Broadband plan can only be offered to subscribers working at homes / at residence for personal purpose.
b. Subscribers having connection in the name of company firms, shops, education institutes or any other commercial entity can be given only
Corporate Plans. They are not eligible for Residential Broadband plans.
c. Connection working in individual names at commercial business/office premises are also not entitled for Home plans.
17. EXPL shall endeavour to provide reliable & efficient services to its customer.
18. EXPL may update its Internet services, provide new facilities, modify & delete certain features, upgrade its network capacity, bandwidth, spe ed,
add new nodes & reconfigure its network as per need without prior intimation.
19. EXPL may revise the tariff for its Residential Broadband Services & its Value-Added Services from time to time at its own discretion.
20. Technician charges will be applicable if the users face issues with third party devices and wants a technician visits their residence.
21. Reconnection of services – account will be suspended if NOT recharged within 3 months. Reconnection charges are applicable.
22. If payment done via Cheque, connection will be processed once cheque is cleared. If Cheque bounced, return charges of Rs.350/ - will be
applicable.
23. If customers want to activate their future plan, the existing plan data or valid days will not be carried forward the future plan.

RIGHT TO TERMINATE SERVICE:

1. EXPL reserves the right to disconnect the service to any customer in case there is sufficient evidence of the customer intentionally or
unintentionally using the service in a manner which would adversely impact EXPL.
2. The customer shall be responsible for using the service only for legal and appropriate purposes.
3. EXPL reserves the right to terminate the services in the event of non-payment of bills preferred by EXPL in accordance with the tariff plans opted
by the customer and the extent of usage or any default on the part of customers.

THE CUSTOMER UNDERSTANDS AND ACKNOWLEDGMENT THAT:

1. Mode of connectivity will be Fiber optic which is over head, EXPL gives no guarantee of cable cut. Reporting of a cable cut shall be attended and
resolved at the earliest.
2. Necessary Installation charges is payable to EXPL for connecting Modem/ONU another Interface equipment etc. as applicable and the same is non-
refundable / non-transferable. The customer is required to complete necessary formalities at EXPL office.
3. Forgery of any identification or obscuring of hostnames, usernames, IP addresses or any message header information in any data is not permitted.
4. Sending harassing or threatening transmission over EXPL leased Internet service is not permitted.
5. Internet contains unedited materials some of which may be sexually explicit or offensive & provocative for which EXPL has no control.
6. Messages or communications, which are inconsistent with the established laws of the country cannot be created, downloaded or accessed.
7. Customer acknowledges the Terms and Conditions of the offers & policies which are mentioned on the website.
8. If subscribed to OTT services through EXPL, the customer acknowledges the Terms & Conditions mentioned on the website (www.ex pl.in).
9. Customer accepts total responsibility and risk for use of the Internet Services and is in compliance with all the applicable laws including but not
limited to Information Technology Act, 2000 and the Rules made thereunder.

Subscribers Signature