Application form Step 1: Enter Your Postcode Step 2: Self Certify This section is for you to self-certify that you cannot currently make or receive indoor calls reliably at your main office/residence, using your mobile with your current mobile network operator (MNO) Please tell us if you are applying as a resident, business or both: Resident Business Both Do you work from home? Yes No I certify that I cannot currently make or receive indoor calls reliably from my primary office premises/main residence, using my mobile with my current mobile network operator (MNO). I certify that I comply with all eligibility requirements of the mobile boost voucher scheme applicable to me as a residential beneficiary applicant or SME beneficiary applicant, including as set out in Schedule 1 (Beneficiary Eligibility) of the scheme's Beneficiary terms and conditions Please select your current mobile network operator (MNO): Please select... Asda Mobile BT EE giffgaff iD Mobile O2 Plusnet Mobile Sky Mobile SMARTY TalkTalk Mobile Tesco Mobile Three Virgin Mobile Vivo Vodafone VOXI Other Step 3: Select Your Address Step 3a: Please enter your address House Name/Number (required): First Line Address (required): Second Line Address: Third Line Address: Step 4: Further Information Title (required): Please select... Dr Miss Mr Mrs Ms Prof First Name (required): Last Name (required): Your Email (required): Data ProtectionAny personal data provided by you as a residential beneficiary, or by your employees, company representatives or otherwise if you are a corporate beneficiary, shall be used by Devon County Council and Somerset Council (from here on referred to as DCC/SC) in accordance with our privacy policy.Please note that it will be down to you to contact your supplier of choice, providing them with the required information for them to be able to install a service at your premises. However we may have to communicate with suppliers and other third parties during the length of the scheme as set out in our privacy policy.Beneficiary Terms and ConditionsYour participation in the mobile boost scheme will be subject to your agreement and compliance with the terms and conditions. Please read these terms and conditions for full details of the terms governing a beneficiary of the mobile boost scheme. I certify that I have read and agree to the above data protection, privacy policy and beneficiary scheme terms and conditions.
