Monarch MVP - Application Form

SELECT YOUR CURRENT SERVICE PROVIDER *

Here's how you can find your current service provider?

1. Dial 611 on your mobile device and listen for the service provider's name

2. Calling the California Lifeline Administrator at 877-858-7463 (tolls may apply). Monday-Friday, 7 AM to 7PM (excluding state holidays)

3. Log in to your account on the CA Lifeline Customer Portal: https://www.californialifeline.com/en/account/login

Caution: If you enter the wrong provider's name, the transfer will NOT COMPLETE and you will not be able to transfer your service to any company for 24 hours.

Consent to Transfer California LifeLine Benefit

I Consent, that want to transfer my California LifeLine benefit to Monarch MVP, SafetyNet.

I understand that if my California LifeLine benefit is transferred my LifeLine service with my current California LifeLine Service Provider will immediately end.

By signing this form, I affirm and agree that I am knowingly and voluntarily authorizing the transfer of my LifeLine benefit from my current Service Provider, to Monarch MVP, SafetyNet my new Service Provider.

I consent to the use of this electronic form and understand I can request a paper copy of terms, associated fees, or enroll using non-electronic methods by calling 1-844-946-6768. This consent may be withdrawn at any time before service activation.

I authorize Monarch MVP, SafetyNet, and their partners to collect, use, share, and retain my personal information, including details required for Lifeline eligibility, enrollment, and compliance. This information may be shared with USAC for program administration. I understand that failure to provide consent will result in denial of Lifeline benefits and service.

I consent to be contacted by Monarch MVP via email, phone, text message, or mail for application processing and marketing purposes, including through automated systems or prerecorded messages. Consent for marketing is not required for service and can be revoked anytime by replying "STOP" to a text, unsubscribing from an email, or calling 1-844-946-6768.

Standard message and data rates may apply, and message frequency may vary. Reply "HELP" for assistance or see full details in the Terms and Conditions and Privacy Policy at https://www.safetynetwireless.com/terms/.

Lifeline Disclosures, Consents and Certifications

Lifeline is a government benefit program from the Federal Communications Commission (FCC) providing discounts on broadband and/or voice services. Providing false information to obtain this benefit can result in fines, imprisonment, de-enrollment, or being barred from the program.

1. One Benefit Per Household: Only one Lifeline benefit is allowed per household. A household is defined as individuals living at the same address and sharing income and expenses. Receiving Lifeline benefits from multiple providers is a violation of FCC rules and will result in de-enrollment.

2. Eligibility and Verification: Eligibility for Lifeline is determined through the National Verifier, National Lifeline Accountability Database, or FCC-approved alternatives administered by USAC. For more information, call 888-224-3213 or visit usac.org/lifeline.

3. Terms and Conditions: By submitting your application, you agree to SafetyNet's Terms and Conditions, including Acceptable Use and Privacy Policies, available at safetynetwireless.com.

Certifications

By continuing, you acknowledge the following under penalty of perjury:

I meet Lifeline's income-based or program-based eligibility criteria per FCC rule 47 C.F.R. § 54.409.
I will notify SafetyNet within 30 days if I no longer qualify for Lifeline or if my household receives more than one Lifeline benefit.
If I qualify as a Tribal resident, I live on Tribal lands as defined in FCC rule 47 C.F.R. § 54.400(e).
If I move, I will provide my updated address to SafetyNet within 30 days.
My household will receive only one Lifeline service, and, to the best of my knowledge, it is not already receiving one.
The information provided is true and correct, and I understand false statements are punishable by law.
I understand I may be required to re-certify my eligibility at any time.

Benefit Transfer Consents

If I am transferring my Lifeline benefit from another provider to SafetyNet:

I understand my benefit will be applied to SafetyNet services and will no longer be applied to my previous provider.
I may lose service or be charged full rates by my former provider if I continue using their services after the transfer.

By signing below, I certify that I have read, understand, and consent to the disclosures, certifications, and terms outlined above for enrolling in Lifeline with SafetyNet.

Applicant's Signature

Please select the Lifeline-eligible subsidy that you receive or your qualifying annual income *

Residence Address *

SELECT YOUR CURRENT SERVICE PROVIDER *

Lifeline Disclosures, Consents and Certifications

Certifications

Benefit Transfer Consents