CHANGE OF OWNERSHIP GLOBAL ENTERPRISE & SERVICES TO GLOBAL ENTERPRISE & SERVICES TRANSFER REQUESTS
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1 Application Form CHANGE OF OWNERSHIP GLOBAL ENTERPRISE & SERVICES TO GLOBAL ENTERPRISE & SERVICES TRANSFER REQUESTS Both parties should fill out this form and read all terms and conditions before signing. Please ensure that all information supplied is correct. On completion this form should be scanned and ed to or faxed to PART A SERVICES TO BE TRANSFERRED (Outgoing Customer who is transferring their services to complete.) A full list of your services and account numbers can be found on your latest Telstra bill. Please note: if you list service numbers, you are agreeing to transfer only those individual services to the Incoming Customer if you list account numbers, you are agreeing to transfer all services on those accounts to the Incoming Customer. Service or Account Numbers Services to be transferred can include but are not limited to: Mobile Services Fixed Internet. Please attach additional services on a separate sheet if required. Services with another carrier will not be transferred. Inbound Services 1800, 1300 and 13 Numbers Inbound Service Number Account Number Is this an EROU Number? * An Enhanced Rights Of Use (EROU) inbound number is one with specific Owner Rights Of Use (ROU). You cannot transfer unless you have legal title.
2 Option 1: Have you arranged to change the name on each EROU number on the SmartNumbers website to reflect the name of the Incoming Customer? Option 2: Have you attached a signed letter on company letterhead stating that you give the Incoming Customer permission to use your EROU Number(s)? Transfer Date (for all services or accounts listed) What date should the transfer of services take effect? The transfer date cannot be earlier than 7 working days from the date that this completed form is submitted to Telstra including all required information. PART B OUTGOING CUSTOMER (This is the customer who is transferring their services.) Your business information Company name Trading name Your business information You must be an Authorised Representative of the Outgoing Customer to request this transfer. If you require assistance in completing the form, contact your Service Delivery Team. ACN/ABN/ARBN Billing address Suburb Postcode Letter of Authority attached ( ) I am the Authorised Representative of this account. Agreement Outgoing Customer to Sign (this is the customer who is transferring their services) Important information On behalf of the Outgoing Customer, I request that Telstra transfer the services listed above to the Incoming Customer whose details are included in Part C of this form and I acknowledge that: I will remain liable for all debts incurred on the services listed above prior to the date of transfer and for any applicable Early Termination Charges acceptance of this request by Telstra is subject to Telstra s ordinary credit approval process I have read and understand all statements made in this application form, and I agree that I will not seek to recover any loss I have suffered or may suffer (either directly or indirectly) as a result of this transfer. I warrant that I am authorised to make this request on behalf of the Outgoing Customer. Name Terms and conditions Please ensure you read and understand all terms and conditions before signing. Position Signature Date
3 PART C INCOMING CUSTOMER (This is the customer who will be receiving the services.) You want these services added to your existing account. Your account information Company name Your account information If you require any assistance in completing the form, contact your Service Delivery Team. Trading name ACN/ABN/ARBN Account number or existing service number Authorised Representative information I am an Authorised Representative of this account. ( ) Billing details Bill services to existing account or New account For existing Telstra account please specify your account/full national number (FNN), billing reference ID and billing aggregator number (if applicable). Existing account number/fnn Billing reference ID Billing aggregator number For new accounts please specify the address (in Australia) you want your bill sent to. Billing address Suburb Postcode White Pages If you require White Pages listing, please state numbers (except 13, 1300, 18 and 1800 inbound numbers) to be listed: 1. ( ) Phone or Fax 2. ( ) Phone or Fax White Pages te: Any existing White Pages listing will be removed if this section is left blank. For additional listing information including advertising 13, 1300, 18 and 1800 inbound numbers please contact White Pages on ( ) Phone or Fax 4. ( ) Phone or Fax 5. ( ) Phone or Fax 6. ( ) Phone or Fax
4 Pricing Plan List the pricing plan the service is to be connected to. The pricing plan should be selected out of the range of plans available to you under Our Customer Terms and, if applicable, your agreement with us. te: If the plans are different for each service, list on an attached spreadsheet. Barring (optional) Full Access or please tick the service type below to be barred (this means that the service below will not be accessible on transferred services): Local Trunk Operator STD IDD 190 If certain services to be transferred are to have specific barring requirements, please attach separate list. Service will default to full network access. Preferred long distance carrier Fixed to Mobile and International Direct Dial Carriage Service Provider Telstra Other Service will default to Telstra if this section is left blank. Inbound Services 1800, 1300 and 13 Numbers EROU details I am the registered ROU holder for the EROU number(s) or I acknowledge and agree to continue the lease EROU number(s)/phoneword(s) from Telstra or I have a licence to use the EROU number(s)/phoneword(s) from a third party (please attach agreement for use of number) Please list the Authorised Representatives to make changes to your Inbound services and please provide their details (if you need more space, please provide on a separate sheet) Password Inbound Authorised Inbound Authorised Representative 1 Representative 2 Level of approval All additions, moves or changes All additions, moves or changes Service Manager Service Manager Redirection only Redirection only Service Manager are enhanced features of Inbound Services, which gives you the ability to make basic moves and changes to existing services 24 hours a day, 7 days a week. Incoming Customer ID requirement You must also provide a Letter of Authorisation on company letterhead and signed by a Company Director or Authorised Representative of the Company. I have attached the required ID documentation to this form. OFFICE USE ONLY Ensure the Incoming Customer has attached Outgoing Customer s Letter of Authorisation.
5 Agreement Incoming Customer to Sign (this is the customer who will be receiving the services) Important Information Before agreeing to take over the ownership of the services listed in Part A, you should satisfy yourself of the details of the services. You may want to contact the Outgoing Customer or Telstra to discuss this. The services may not be able to retain the service plans and may need to be moved to an appropriate plan available to you under Our Customer Terms and, if applicable, your agreement with us. The services listed in Part A will be transferred along with any additional products attached to those services, if the additional products are available under your Incoming Customer Telstra agreement. You agree and will ensure that your personnel, your related bodies corporate and their personnel, and any individuals, who receive services or whose information is disclosed to us, in connection with this form, are aware that we may use and disclose information about you and each of them in accordance with our Privacy Statement (as amended by us from time to time), which is available telstra.com.au/privacy/privacy statement.html or by calling us on On behalf of the Incoming Customer, I request Telstra transfers the services listed in Part A from the Outgoing Customer, whose details appear in Part B of this form to me, the Incoming Customer. I agree: that if Telstra accepts this request, the above services will be provided by Telstra to me, the Incoming Customer, in accordance with Our Customer Terms (located at telstra.com.au/customerterms/index.htm), this Change of Ownership Form and any Telstra agreement with me acceptance of this request by Telstra is subject to, amongst other things, Telstra s ordinary credit approval process and acknowledge that I have had the opportunity to review a copy of Our Customer Terms and acknowledge that I have read and understand all statements made in this form I will be liable for all debts incurred on the services listed above from the date of transfer, and I will be liable for all outstanding charges for the fixed and internet services listed above. I warrant that I am authorised to make this request on behalf of the Incoming Customer. Name Terms and conditions Please ensure you read all terms and conditions before signing. Position Signature Date OFFICE USE ONLY If this form is being processed by a Channel Partner, please provide your Dealer Code and Contact Information: Dealer Code Contact name Contact The following components have been completed in store Mobile Fixed Internet Other Smartnumber is a trade mark of the Australian Communications Authority. Telstra Corporation Limited is an authorised representative of Asurion Financial Services Pty Ltd, AFS Licence and are trade marks and registered trade marks of Telstra Corporation Limited, ABN C261 AUG14
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