Inmarsat C – Special Access Codes

Application for Xantic services

Inmarsat-C SPECIAL ACCESS CODES (SAC)

Please mail or fax the completed form to Xantic Customer Services:

Email: Fax: +61 7 5498 0098 or +31 70 343 4796

For quality reasons please do complete this form in capital letters only

¨ REGISTRATION New customer, please fill in this form starting from Section 1.

¨ REGISTRATION Existing Customer

Please provide your Xantic Billing Account Number and start at Section 3

(Start at Section 1 if you want to open a new billing account for this service)

¨ MODIFICATION for changes to existing registrations please start from Section 4.

1.  Name and address of (prospective) user of Xantic services
Name Company
......
Contact person Mr / Ms / Title
......
Address
......
Postal Code/ZIP Code City
………………………………………………………………………………………………
State Country
......
Telephone number Fax number
...... ….....
E-mail address
......
VAT number (only for companies in the European Union registered for VAT) ...... …
I want the confirmation to be sent to the following email address: ………………..
PAYMENT
2.  To whom and which address should the bills be sent for Bank payment?
¨ Same as in question 1
¨ To a different address (provide details)
Name Company
......
Contact person Mr / Ms / Title
......
Address
......
Postal Code/ZIP Code City
………………………………………………………………………………………………………...
State Country
......
Telephone number Fax number
...... / ¨ Private use
¨ Business use
Field of activity
MARITIME
¨ Navy
¨ Merchant
¨ Fishing
¨ Offshore
¨ Land
¨ Yachting / Leisure
¨ Cruise / Ferries
¨ Other ……………..
LAND MOBILE
¨ Peace, Aid, NGO’s
¨ Defense &
Government
¨ Media, Press &
Broadcasting
¨ Oil, Gas & Energy
¨ Mining
¨ Transport
¨ Other …………….
AERO
¨ Commercial
Aviation
¨ General Aviation
NON END-USERS
¨ Carrier
¨ Carrier –SLES
¨ ISP
¨ ISP-LESO
¨ Other ………….
Xantic - Inmarsat C services
SPECIAL ACCESS CODES (SAC) application form

See explanatory notes on the back of this form

3.  REGISTRATION New Inmarsat-C Special Access Code (SAC)

A. Special Access Code Category ¨ Easy Code (Standard)

¨ Green Code (Reversed charging, communication costs assumed by

addressee)

¨ Info (to be arranged in special project: fee to be paid by mobiles

includes price communications plus content price)

B. The expected number of messages ¨ per day ......

¨ per week ......

¨ per month ......

C. The average expected message length No. of characters ......

D. Please provide a short description of what the Special Access Code will be used for:

......

......

E. Destination

Please indicate destination (only one address possible) provide number and Country code where applicable

¨ PSTN (telephone modem) Number: ......

¨ PSDN (X25) Number: ......

¨ Fax, Number: ......

¨ Telex, Number: ......

¨ Inmarsat-C mobile Number: ………………………………… Number: ......

¨ E-mail, Address: ......

¨ Xantic Mailbox (retrieval by addressee) Number (*): ......

(*) please provide an address for delivery if mailbox is full

F. Which LES ID do you prefer to use?:

¨ 12 or ¨ 22 ¨ both

4.  MODIFICATIONS: please change destination address of following SAC

Customer account number: …………………………

SAC code: …………………

New delivery address: ……………………………………………………………

Xantic - Inmarsat C services

SPECIAL ACCESS CODES (SAC) application form

Signature

5.  The contracting party agrees to the Xantic service, tariffs and payment conditions related to this service. Applicable to this request and the possible contract emerging of it, are the "Xantic General Terms & Conditions for Airtime and Value Added Services End-User Agreement” attached to the “Xantic Airtime and Value Added Services End-User Agreement”. If you are a new customer, please request a copy of this Agreement from our Customer Service Centre () and return it signed by fax/ post.

Please be aware that registered users that SAC codes that have not been used during more than 6 consecutive months may be deleted from our system. For more information on conditions and tariffs contact your Xantic Sales Manager or Xantic Customer Services (see contact details below).

I hereby declare that:

a.  I am the owner of the Inmarsat-C mobiles OR I have obtained written authority from the owner/s of the mobiles mentioned in this application form.

b.  I am responsible for paying the Xantic charges for Data Reporting incurred by the mobiles registered sending messages to the SAC code (in case of a Green code).

For applications on behalf of companies and other organisations a duly authorised person must sign

Name contracting party or assignee City Date Signature

...... ……………………………………………………………………………………………………......

Remarks Xantic Sales

......

New Xantic customers should fax at least this last page to + 61 7 5498 0098

The rest of the form can be sent digitally to

www.xantic.net
Xantic Customer Services
Email:

Access via Australia

Tel: +61 7 5498 0000
Fax: +61 7 5498 0098
Telex: (71) 22432 TELCSC AA

Access via the Netherlands

Tel: +31 70 343 4543
Fax: +31 70 343 4796

Explanatory notes for the completion of the Xantic Application for:

Inmarsat C – Special Access Codes

Service Description

·  Inmarsat-C Special Access Codes

A form of easy addressing, making the addressee easier to contact through "easy codes" and "green codes" (where recipient pays communication costs). Costs include an initial registration fee of 20 USD, and a standard yearly price of 160 USD for an Easy Code and 240 USD for a Green Code. There are no surcharges on communication costs.

·  Paid Info code:

By means of this type of SAC code customers could distribute information among their customers. The price associated to this code would include the communication costs as well as a fee for the content provided. This kind of SAC code are set up only on project basis. For a paid Info code please contact your sales manager at Xantic.

·  Charges messages

Charges for calls to the SAC codes are per 256 bits , expressed in US dollars (USD). Australian customers will be billed in Australian dollars (AUD). For information about messaging charges please contact Xantic Customer Services.

Form edited on 05/11/03 / ml Page 3 of 3