CONSENT FORM FOR LIFELINE ENROLLMENT APPLICATION

Lifeline services are subject to availability and Telxmedia Inc's Terms and Conditions.

Provider Name: Telxmedia Inc
Effective Date: 07/17/2026

Service activation and usage requirement:

Telxmedia Inc service is a prepaid service offered by the company to subscribers eligible for Lifeline discount benefits in states where it is authorized to do so. To maintain your service and benefits, you must personally activate the service by initiating data usage, or by responding to instructions from Telxmedia Inc to activate the service. To keep your account active, you must use the service at least once during a 30-day period by completing an outbound call, sending a text message, using cellular data, purchasing additional service from Telxmedia Inc, answering an in-bound call from someone other than Telxmedia Inc, or by responding to a direct contact from Telxmedia Inc confirming that you want to continue receiving service from Telxmedia Inc.

If your service goes unused for 30 days, you will no longer be eligible for program benefits and your service is subject to a 15-day cure period during which you must use the service (as described above) in order to fully re-activate your service and remain enrolled in the Lifeline Program.

I hereby certify that I have read and understood the disclosures listed above regarding activation and usage requirements.

Lifeline Disclosures, Authorizations and Certification

1. Program Eligibility Verification: I certify that the information provided in this application is true and accurate to the best of my knowledge. I understand that the Lifeline Program is a government assistance program that provides a discount on telecommunications services to eligible low-income households.

2. One Lifeline Benefit per Household: I confirm that my household does not currently receive more than one Lifeline benefit. I agree to notify Telxmedia Inc or the Lifeline Program Administrator immediately if I or anyone in my household receives a second Lifeline benefit.

3. Use of Information: I consent to Telxmedia Inc and the Lifeline Program Administrator using the information I provide to:

• Verify my eligibility through federal and state databases.
• Confirm my continued participation in qualifying programs, if applicable.
• Comply with Lifeline Program rules and audits.

4. Annual Recertification: I understand that I must annually recertify my continued eligibility for Lifeline benefits and may be required to respond to requests for documentation. Failure to do so may result in the loss of Lifeline benefits.

5. Acknowledgment of Responsibilities: I acknowledge that I am responsible for notifying Telxmedia Inc of any changes in my eligibility status, including:

• Changes to my qualifying program participation.
• A move to a new address.
• The addition of another Lifeline benefit to my household.

6. Penalties for Misrepresentation: I understand that providing false or fraudulent information to receive Lifeline benefits is punishable by law and may result in fines, imprisonment, and removal from the program.

7. Authorization: I authorize Telxmedia Inc and its contracted partners, for the purpose of applying for, determining eligibility, enrolling in and seeking reimbursement of Lifeline service and device benefits, to collect, use, share and retain my personal information, including, but not limited to, full name, full residential address, date of birth, last four digits of social security number, telephone number, eligibility criteria and status, the date on which the Lifeline service discount was initiated and if applicable, terminated, usage status and other compliance requirements, the amount of support being sought for the service and/or device, and information necessary to establish identity and verifiable address, to USAC to ensure proper administration of the Lifeline service and/or connected device benefits.

Failure to provide consent will result in me being denied the Lifeline service benefits.

Privacy Notice

Telxmedia Inc values your privacy. Your information will be handled in accordance with federal and state regulations and used solely for Lifeline enrollment and compliance purposes.

Lifeline Benefit Transfer Consent

A subscriber already enrolled in the Lifeline program with another provider must consent to the transfer of their Lifeline benefit to Telxmedia Inc.

The effect of a Lifeline benefit transfer is that your Lifeline benefit will be applied to Telxmedia Inc program services and will no longer be applied to service retained from your former Lifeline service provider. You may be subject to your former Lifeline provider's undiscounted rates as a result of the transfer, if you elect to maintain service from that provider.

You are limited to one Lifeline benefit transfer transaction per service month, with limited exceptions for situations where a subscriber seeks to reverse an unauthorized benefit transfer or is unable to receive service from a specific provider.

After receiving and reviewing the foregoing required disclosures, I consent to and authorize Telxmedia Inc to transfer my current Lifeline benefit to Telxmedia Inc, if I am found to already be receiving Lifeline discount benefit from another Lifeline provider.

Enrollment Consent

By signing this document, I certify that I have read and understood the above disclosures, agree with the authorizations, and consent to applying your household's Lifeline benefit with Telxmedia Inc as my provider.

I agree that by submitting this application form and completing the eligibility verification process I am consenting to activate my Lifeline benefit and service with Telxmedia Inc.