Augere Wireless Broadband Bangladesh Ltd.

Email: qubee@qubee.com.bd
Helpline: 02 8959911

Static Public IP Subscription Form

Form Serial Number :

Received from:

SS

CC

[A] TERMS & CONDITIONS

By submitting the following information, client is making a formal application for Static Public IP Address, which will become
binding upon confirmation from AWBBL and 3 working days will be taken to get back.
The person confirmed by the applicant as the technical contact will be communicated for any technical issues.
Please note AWBBL will not provide Static Public IP for: Browsing, Gaming Service & SMTP usage.
Static Public IP may not be allocated if the required service by the customer could be served by DHCP IP.
In case of abusing the network by using this static IP :

The respective client will be responsible for any unlawful activities.

AWBBL holds the right to investigate and close the service.

AWBBL holds the right to allocate the static IP to any other user if it remains unused for two month.

Terms & conditions mentioned in the original Subscriber Application Form (SAF) will also remain valid & applicable.
AWBBL will not be responsible for any business loss or any other consequence of the client in case of any temporary service
disruption.

[B] CUSTOMER INFORMATION

Account No.

Q U B E E

A/C Name

Phone No.

Email

Username

MAC ID.

Billing address:
[C] TECHNICAL INFORMATION
Package speed

Name of the Organization

Req. 1 mbps or above

Type of Business

No. of required IP

Technical Contact Name

Phone No.

Email

Please specify purpose of using static IP:

DNS Server

Domain Name

____________________________________________________

Mail Server

Domain Name

____________________________________________________

VPN Service

Source IP

_________________

Web Server

Domain Name

____________________________________________________

FTP Server

Domain Name

____________________________________________________

Other

Specify

____________________________________________________

Destination IP

__________________

STATIC PUBLIC IP SUBSCRIPTION FORM

Augere Wireless Broadband Bangladesh Ltd.

Email: qubee@qubee.com.bd
Helpline: 02 8959911

Static Public IP Subscription Form

[D] SIGNATURE & DECLARATION OF THE COMPANY REPRESENTATIVE
I, the undersigned, hereby certify that,

In case of any abusing through this Static Public IP, the respective user will be responsible for that. AWBBL has the
rights to investigate and close the service for that client.
If the Static Public IP is unused for more than 2 months, AWBBL has the rights to suspend that Static Public IP.
AWBBL keep the full rights to allocate and take over the Static Public IP from any Qubee subscriber.

Name: ____________________________________________

Designation: ___________________________________________

Contact Number: ___________________________________

AUTHORISED SIGNATURE (with company stamp/seal): _______________________________________ Date: _______________

FOR QUBEE USE ONLY

QUBEE Head of Sales/Customer Service:
Name
Department

Sales

Customer Service

Phone No.

Signature:
Received Documents
Subscriber Application Form (SAF)

Company trade license

Application in company letterhead

QUBEE Technology :
Name of implementer
Department

IT

Phone No.

NOC

Allocated IP Address
Date of Allocation

Date of Expire

20
dd

mm

yy

20
dd

mm

yy

Remarks

Signature:

STATIC PUBLIC IP SUBSCRIPTION FORM