Walesi Application Form – Walesi

Government Subsidy Platform

Walesi is a Fijian Government owned – digital Television company responsible for providing FREE TV to all Fijians. As part of the initiative, Walesi is providing Free Set Top Boxes to every household that has a combined annual income of $30,000 and below.

Download Walesi Application Form

TYPE

Application for:*

Set Top Box

Satellite Dish kit

SECTION A. PERSONAL INFORMATION

Phone*

Full Name*

Title

First Name

Last Name

Postal Address*

Date of Birth*

Residential Address*

Email address*

SECTION B. IDENTIFICATION

EFL BILL*

VALID ID CARD*

PAY SLIP*

Other Supporting Document's

Application Option*

If you are applying for government subsidy, please continue on to sections C, D, E & F. OR If you are purchasing your Walesi Set Top Box outright, please submit completed Section A, B & D to our office.

Apply for Government Subsidy

Purchase Walesi Setup Box

Warning: Providing false information to Government is an offense under the False Information Act 2016. If you are found guilty of providing false information to Government, you may be fined up to $20,000 or sentenced to prison for up to 10 years.

SECTION C. HOUSEHOLD DETAILS

No. of Adults in household*

No. of Children in household*

List of Wage earners in household & Annual income (gross):*

Full Name and Annual Income*

Note: annual income before tax & FNPF deductions

Full Name and Annual Income*

Note: annual income before tax & FNPF deductions

Full Name and Annual Income*

Note: annual income before tax & FNPF deductions

Full Name and Annual Income*

Note: annual income before tax & FNPF deductions

Full Name and Annual Income*

Note: annual income before tax & FNPF deductions

Full Name and Annual Income*

Note: annual income before tax & FNPF deductions

SECTION D. PLACE OF INSTALLATION

Please tick which type of power source you will be using:*

Generator

Solar Power

EFL Power

Energy Fiji Limited (EFL) Account Number:*

SECTION E. DECLARATION

Acceptance*

I submit my declaration for point A to E mentioned below

(A) the gross annual income of my household (persons living in the same house) is $30,000 or less; (B) to the best of my knowledge, no other member of my household has applied for, or is planning to apply for, the assistance under the Walesi Subsidy Programme; (C) I have not already recieved a Set Top Box from Government under the subsidy programme; (D) I will install and use the Set Top Box only at my place of residence; (E) I understand that the provision of false information to Government for the purposes of recieving a benefit is an offense under the False Information Act 2016 and may result in a requirement to repay the benefit, a fine of up to $20,000 or an imprisonment term of up to 10 years or any or all of the forgoing.

SECTION F. DECLARATION SIGNATURE

Acknowledgement*

solemnly and sincerely declare that the information contained in this form is true and correct and I make this solemn declaration believing the same to be true and by virtue of the Statutory Declarations Act (Cap.43).

Full Name*

Title

First Name

Last Name

Declaration Date*

Witness Full Name*

Title

First Name

Last Name

Witness's Phone*

Note:

Application Processing Time: 3-5 working days.

Customers to collect Walesi Set Box from the nearest Customer Care Center.

This field should be left blank