Validated By:

SUBSCRIBER APPLICATION FORM (SAF)

Philippine Multimedia System, Inc. (PMSI)

Dream TV Direct To Home Satellite Service

Contract No.

IMPORTANT:
Subscriber Name:

Accurate and up to date contact information is necessary for Subscribers' participation in future raffle promotions and updates for DREAM TV.
Last First M.I.

ID Presented: Residence Add:

No. Street

Other ID:
Town / City Province

Telephone No. : Mobile No. : Other Mailing Add: Proof of Mailing Add. Presented: Name of Spouse (if applicable) Subscription Plan:

Birthdate: Email Add:

Years in Residence: Zip Code:

Contact No.

SUBSCRIBER DECLARATION
1. 2. 3. 4. 5. I affirm that the above information are true and correct, that the supporting documents attached are authentic and voluntary submit these in connection with my application for the Dream Service. I am fully aware that all IRD/Decoders in the Family Package/ Residential Bundle is located in the same residential location. I fully understand the subscription fees, package rates and charges for my subscription to Dream Satellite TV and agree to pay the same in accordance with their due dates. I understand that the installation charges of the installer/dealer is not part of the PMSI service and is agreed to between the installer/dealer and the Subscriber. I hereby confirm I have read the Terms and Conditions on the reverse side of this form and that I shall comply with them.

Subscriber Authorized Signature

Date Sticker 2 Sticker 3

FOR PMSI / DEALER'S USE ONLY

Sticker 1

DEALER/DISTRIBUTOR CERTIFICATION
The information entered into this SAF has been confirmed and documented in accordance with PMSI requirements. Installation has been assigned to my accredited dealer.

INSTALLER CERTIFICATION
I certify that the installation was done following the standards of PMSI at the address indicated below. I understand that any misrepresentation on the above may result in the revocation of my accreditation as an installer.

User's Name Name & Signature of Dealer User's Installation Address Address of Dealer Installer Name Mobile / Telephone No. Telephone Number

BUSINESS OFFICES & CONTACT DETAILS

Call Center: NCR : Calamba : Dau : Cebu : Tel. 02-9188000 Tel. 02-8898292 Tel. 049 - 5457219 Tel. 045 - 8932363 Tel. 032 - 3438946 Fax 02 -7440722 Fax 02 - 8898131 Fax 049 - 5457219 Fax 045 - 6240459 Fax 032 - 4203944 Iloilo : Bacolod : Davao : Cag. De Oro: Tel. 033 - 3351344 Tel. 034 - 4340168 Tel. 082 -2353615 Tel : 088 - 8568588 Fax : 036 - 6211075 Fax : 034 - 7090550 Fax : 082 - 2341135 Fax : 088 - 8568588

OTHERS

Customer Hotline No. 02 - 9188000 Website : www.dream.com.ph

Series 3/2006