CONTRACT FOR PROVIDING SERVICES OF ELECTRONIC COMMUNICATION
(Telecommunication services – service order form)
Internet service viaGIA / digital cable TV service viaTV / telephone service viaPhone
Signed pursuant to Section 51 of the Civil Code of the Czech Rep. and to Section 269(2) of the Commercial Code of the Czech Rep.
Contract no. viaGIA: / Contract no. viaTV: / Contract no. viaPhone:Intermediary’s ID: / Security number:
Provider
T-Systems Czech Republic a.s., incorporated in the Commercial Register maintained by the Municipal Court in Prague, Section B, Entry No. 3938, with its registered office at Na Pankráci 1685/17, 19; 140 21 Prague 4; Company ID: 61059382, Tax ID: 010 – 61059382;Bank Details: Česká spořitelna (CR) Inc., Václavské nám. 56, Prague 1, Bank Account No.: 1905602/0800
Customer
Company / Name: / Surname: / Title:Incorporated in the Commercial Register maintained by: / Section / Entry No.: / /
Registered Office / Address of the Permanent Residence of the Customer: 1)
CID no. / PID: 2) / Passport no.: 2) / TAX ID:
1) Has to be filled in if different to Service Installation Address or Invoicing Details (address).
2) CID (company ID – companies registered in the Czech Rep.) is filled in by a private entrepreneur / company, other personal entities (Czech citizens) enter PID number (Private Identification card number). Only non-Czech citizens fills in the Passport number.
Service Installation Address / Ordered Services
Locality (name): / Building identification: / Floor:Street: / House no: / Street no: *) / / / Flat no.:
City: / Postcode:
viaGIA service: / I order / viaTV service: / I order / viaPhone service: / I order
Socket identification: 3) / Socket identification: 3) / Socket identification: 3)
3) Identification of the telecommunication socket (a port), on which you want the service activate. Fill in just for the services you are interested in. The identification should be on the socket.
*) house no. - a number of the house within the district (a number on a red plate on the house), street no. - street orientation number (a number on a blue plate on the house),
Invoicing Details (invoicing address, if different) and Payment Method
Street: 4) / House no: / Street no: *4) / /City / City District: 4) / Postcode: 4)
Payment method: / Bank transfer Collection order 5) / Invoices are sent: / electronically 6) via post (charged, see the Pricelist)
Bank: / Account no.:/ Bank code: 5) / /
4) Fill in only when different from the Service Installation Address. If not filled in, the data from Service Installation Address will be used.
5) Collection order (encashment, in Czech Inkaso) – The fees can be also paid by automatic encashment. You have to set up encashment order in your bank, allowing T-Systems to withdraw the service fees each month automatically. See Methods of payment on the other page for details.
6) The electronic invoices are sent always – free of charge.
Contact person, responsible for handover of the service and communication concerning the ordered services
Mobile: / Telephone / fax: / / / E-mail: 7)7) Has to be filled in – the e-mail address is used for communication with T-Systems and for sending a Certificate (necessary for a secure access to a viaGIA e-mail box and other useful data). This e-mail address will be also used for the delivery of news and important information on the services.
Specification of Services (fill in only the specifications of the services you order)
viaGIA – Internet service
Tariff plan of viaGIA service: / Light (speed 15/5 Mbit/s) Comfort (speed 30/30 Mbit/s) Ultra (speed 100/100 Mbit/s)Contract length (duration): / undefined period 12-month contract 24-month contract / Router - sale: (optional): 8) / DIR-100 DIR-600
Fixed IP address: / yes (optional, see the Pricelist) / Requested activation date: 9)
8) The router is not a necessary device for viaGIA, but it is used quite often (see the section “viaGIA – Supplementary devices“ at www.viahome.cz. The router can be purchased for the full price (at undefined period contract) or for a discounted price (at defined period contracts), see the Pricelist. In this Contract just check the router type, if any, the proper price will set up automatically.
9) Requested date of service activation - If not entered, the service will be activated on the nearest possible date.
viaTV – digital cable TV service
Program offer of viaTV service: / Basic Complet Premium Cinema / Requested activation date: 9)Set-top box (lease/purchase): 10) / Lease: basic price 12-month contract 24-month contract
Purchase: sale of the set-top box to customer’s ownership / Set-top box (type) / Motorola VIP 1003
10) A set-top box can be rented or purchased, fees according to a valid Pricelist. The set-top box is a necessary device for usage of viaTV service.
viaPhone – telephone service
Tariff plan of viaPhone service: / Standard Combi (only with viaGIA or viaTV service) Combi Plus (only with viaGIA or viaTV service)Contract length (duration): / undefined period defined period for 24 months / Requested activation date 9)
Type of usage of the service: / personal business and others / Detailed list of calls 11) / establish
Telephone number transfer (optional)12) / yes / Telephone - sale (optional): / Siemens C590/610 IP Cisco SPA 303 Linksys PAP2T
11) Regular detailed outgoing calls printout via electronic mail (send once a month) – free of charge..
12) Fill in only in case when you wish to terminate your contractual relationship with another telephone provider and keep your current phone number (only within Czech numbers!) for viaPhone. In this case, Annex No. 5 – Portability of a geographic number, shall be filled in. In case the number is not transferred, the Customer is automatically assigned a new number free of charge.
Telephone directory – method of release of the Customer’s details in the telephone directory:standard release – name, surname, academic degree (for natural persons), trade name or name; or e-mail address and nickname / details not to be released at all
E-mail: / Nickname:
Ban on data use pursuant to Sec. 95 of Act No. 127/2005Coll., for the purposes of direct marketing: / yes
viaGIA, TV, Phone – device delivery (if any ordered)
Předání zařízení 13) / personal pick-up delivery to locality (charged according to valid Pricelist; the price remains the same regardless of number of device delivered)13) A personal pick-up (withdrawal) at the Provider´s facility is free of charge; delivery to the locality of installation – the fee according to a valid Pricelist (an exact term must be agreed in advance)
Final provisions:
1.1. The contractual relationship based on this Contract shall be governed by the Czech legal order, by the Contract and the Business Terms and Conditions of the T-Systems Czech Republic a.s. issued by the Provider for the individual types of telecommunication services.
1.2. The service is activated with respect to the Provider’s possibilities, as close as possible to the required date of installation, usually within 14 days as from the required date of installation. In case of not filling in the requested date of installation, the service will be activated usually within 14 days as from the signature of the Contract by last party to sign the Contract.
1.3. The customer declares that he is the owner of the apartment, in which the installation of the service is to be realized or that he has a valid contract of lease for the apartment concluded with its owner. Should this condition fail to be fulfilled, then the customer shall submit the apartment’s owner’s consent with the installation of the service, authenticated by a public notary, submitted together with this Contract.
1.4. The customer declares that he has no debts against the Provider resulting from a previous or a parallel contractual relationship. Prices for the provided services and relating work as well as the price-related conditions shall be specified in the Provider’s Price List, valid to the date of the service provision. The customer undertakes to pay the prices for the provided services within the due dates specified by the Provider in the invoice for telecommunication services.
1.5. The Contract is executed in two copies having the same validity as the original copy, of which either party to the Contract shall be given one copy.
1.6. The Contract shall come into force on the date of its signature by last party to the Contract, and it shall come into effect on the date of the telecommunication service provision commencement under this Contract. The Business Terms and Conditions shall form an integral part of the Contract entered into.
1.7. The end point of the services is terminated by physical interface Ethernet spec. IEEE 802.3 in telecom. socket type RJ-45.
By signing this Contract, the customer expresses his consent with the Business Terms and Conditions and with the current Price List for the services viaGIA, viaPhone and viaTV. The customer declares on their word of honour that the information stated in this Contract is true and complete. Should the Provider discover that the information stated in this Contract is false or incomplete, then the Provider, pursuant to Art.7.1.e of the Business Terms and Conditions, shall have the right to terminate provision of the viaGIA and viaPhone service; or, pursuant to Art.8.1.e of the Business Terms and Conditions shall have the right to terminate provision of the viaTV service.
Annexes to the Contract:
Annex No. 1, 2, 3: Business Terms and Conditions - Business Terms and Conditions of the viaGIA Service of Electronic Communication (Telecommunication Service) of T-Systems Czech Republic a.s.; Business Terms and Conditions of the viaPhone Service of Electronic Communication (Telecommunication Service) of T-Systems Czech Republic a.s.; Business Terms and Conditions of the viaTV Service of Electronic Communication (Telecommunication Service) of T-Systems Czech Republic a.s.
Annex No. 4, 5: Specification of viaPhone (optional) – Specification of viaPhone Additional Services (blocking of outgoing calls to the selected numbers, detailed calls printout); Specification of the Service of Geographic Number Portability to the Service viaPhone (for the purpose of maintenance of the existing telephone number by its transfer from the original operator). The forms may be downloaded from www.viahome.cz or they are available in our Contact Centre upon request - e-mail: info@viahome, Tel.: 236 099 333).
Annex No. 6: Pricelist – Pricelist of Services of Electronic Communications (Telecommunication services) viaGIA, viaTV, viaPhone of T-Systems Czech Republic a.s.
Annex No. 7: Other Annexes:
Note: / No. of annexes:Methods of payments for the viaGIA, viaPhone and viaTV telecommunication services
The viaGIA, viaPhone and viaTV may be paid using either of the following methods:
1. Repeated payment by collection from an account (recommended method of settlement)
For this payment, it is necessary to arrange for the so-called collection order (encashment – in Czech “inkaso”) in your bank allowing T-Systems to collect money for the provided services from your account. Further on, everything proceeds fully automatically and you do not have to care any longer. Within the collection, it is possible to determine the so-called collection limit – a maximum amount, which may be collected on a lump-sum basis within the framework of the respective collection payment (be careful about collection limit concerning payments in case of variable monthly amounts, such as telephone services).
Upon payment via collection, it is necessary to do the following:
· Fill in your account number in the Contract, to the debit of which collection is to be performed
· Arrange for the collection order in your bank and allow for collection to the credit of the below-mentioned account of T-Systems
· Do not fill in variable symbol (it is used as an identifier of the payment)
· Make sure that to the date of maturity (the 14th day in the respective month) there is sufficient balance on your account, to the debit of which collection is performed, so that collection may be executed
This form of payment releases you from the duty to watch the oncoming date of maturity every month and at the same time, you do not lose control over sums, which are to be withdrawn from your account automatically.
2. Lump-sum payment
Upon receiving the invoice, you perform a lump-sum payment, either electronically or in person at your bank. The number of the invoice is to be used as the variable symbol; you should not round the sum.
Bank details of T-Systems (applicable to both lump-sum direct payments and for collection):
Account name: T-Systems Czech Republic a.s.
Account number: 1905602
Bank code: 0800
The method of payment shall be selected beforehand in this Contract. In the course of validity of the Contract, the method of payment may be changed upon agreement with the Provider.
Unfortunately, it is not possible to perform payment by arrangement of a permanent payment order (the variable symbol serves as an identifier of the payment period – it is changed every month). In this case, it would not be possible to identify the incoming payment and you might be unjustly identified as a defaulter. Therefore, we would like to ask you not to arrange for a permanent payment order for payments concerning services provided by T-Systems – this will help you avoid problems with missing or delayed payments.
T-Systems Czech Republic a.s. n Na Pankráci 1685/17, 19; Praha 4, 140 21
Tel: +420 236 099 333 n Fax: +420 236 099 665 n e-mail: n http://www.viahome.cz
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