Emergency Broadband Benefit Disclaimer
I understand that this authorization is only for the purpose of verifying my participation in this program and will not be used for any purpose other than Emergency Broadband Benefit (EBB). You are authorizing the Company, DailyTel, Inc to access any records required to verify your statements on this form and to confirm your eligibility for the Emergency Broadband Benefit program.

For my household, I affirm and understand that the EBB Program is a temporary federal government subsidy that reduces my broadband internet access service bill up to $50 and at the conclusion of the program, my household will be subject to the provider's undiscounted general rates, terms, and conditions if my household continues to subscribe to the service. .

I (or my dependent or other person in my household) currently get benefits from the government program(s) like (SNAPs, Medical assistance etc.), or experienced a substantial loss of income since February 29, 2020, or my annual household income is 135% or less than the Federal Poverty Guidelines (the amount listed in the Federal Poverty Guidelines table on this form). I agree that if I move, I will provide my new address to my service provider within 30 days. I understand that I have to tell my service provider within 30 days if I do not qualify for EBB Program anymore, including: I, or the person in my household that qualifies, do not qualify through a government program or income anymore.

I know that my household can only get one EBB Program benefit and, to the best of my knowledge, my household is not getting more than one EBB Program benefit. I understand that I will receive a tablet/cell phone along with $10 GB internet/month if I haven't got this facility with any other company. If tablet is already claimed with another company, in that case I will only receive a free of cost SIM with min $10GB data through the EBB Program from DailyTel. I hereby authorize DailyTel to enroll me for EBB program. All the answers and agreements that I provided on this form are true and correct to the best of my knowledge. I know that willingly giving false or fraudulent information to get EBB Program benefits is punishable by law and can result in fines, jail time, de-enrollment, or being barred from the program

I have read the file and understood it. The information provided by me are correct to the best of my knowledge.