Opt-in Form

Subscriber Details / معلومات المشترك

Subscriber name "four parts" / "اسم المشترك "أربعة مقاطع: _________________________________________

Nationality /الجنسیة : ________________________ Date of Birth / تاریخ المیلاد : _____________________

National ID / الرقم الوطني : ____________________ ID Type and Number/ نوع ورقم الوثیقة : ____________

Address / العنوان

E-mail/ البرید الإلكتروني : ____________   Post code / الرمز البریدي : ____ P.O. Box / صندوق البرید : _____

Subscriber number /رقم المشترك : _______________   Contact number/ رقم الاتصال : ______________

Street name/ اسم الشارع : ______   Area / المنطقة : ____________   City / المدینة : ______________

Reference Name and Number /  اسم و رقم المرجع
______________________________________________

Terms & Conditions

1. Points can be earned/accumulated if the line is active only; suspended lines will not earn points but will retain their previous balance of accumulated points.

2. Point calculation method is based on last bill amount and/or credit recharges carried-out during that specific month (excluding all applicable taxes).

3. Points accumulated are not transferable; their validity is for a maximum period of twenty four months from date of calculation of points, after which unused points will be considered void.

4. Change of ownership / migrations / deactivation / separation / take-over will result in the reset of the point account back to zero without prior notification.

5. Redemption of accumulated points is applicable to fully active accounts. No redemption of accumulated points is possible if account is suspended or deactivated.

6. Redemption of accumulated points versus a discount on the standard retail price of handsets is valid for post-paid rate plans without an annual commitment. If the discount amount requested exceeds the total handset's price, no refunds will be granted.

7. All applicable taxes are to be absorbed by the account owner.

8. An account owner is the person responsible for all required payments, whereby he/she will be the only person authorized to handle all related issues including but not limited to; inquiries, notifications, redemption, etc...

9. At any time, and at Orange's discretion, subscribers may occasionally receive additional points or rewards without any obligations to any party involved.

10. Any discrepancy in the accumulation/calculation of points must be reported by the account owner within a maximum period of three days from notification date, for investigations and /or follow-ups, after which an account owner loses any right to revert back to Orange. Any statement or SMS notification of points balance should not be considered final and are subject to internal audits on periodic basis to insure accuracy/quality in order to protect the rights of the subscriber and Orange.

11. Orange reserves the right to terminate/change/alter/amend this program or any part thereof, as well as include/exclude any subscriber from this program at any time without prior notice, and shall not be liable for any loss or damage resulting whatsoever, including but not limited to discrepancies resulting from Banks or Credit Card companies or any other party involved in the payment of monthly bills.

12. All rewards redeemed/issued are not refundable.

13. All handsets are subject to availability at Orange shops.

14. Maximum redemption of points per transaction is 200,000 point.

15. Orange customers with direct debit paying method (credit card or bank account), will have to wait until their bills are fully settled through the bank to be able to redeem their points.

I, the undersigned here below, confirm that the information provided is accurate and correct, and agree on the terms and conditions of this application form that are an integral part that cannot be omitted from it. By me signing, I agree to go into contract for the offered service.

أنا الموقع أدناه ، أؤكد أن المعلومات المزودة صحیحة ودقیقة وأوافق على الشروط والأحكام المرفقة بھذا النموذج والتي تعتبر جزءاً لا یتجزأ منھ كوحدة واحدة وبمجرد توقیعي فإنني أوافق على التعاقد في الخدمة المقدمة

Signature /التوقیع :
Date / التاریخ:

For Orange employee use only / لاستخدام موظفي أورانج فقط

Orange Shop :	Signature :
User :	Date :