application form

autopay and mobile pay services

Welcome to Etisalat.
Complete this form if you are applying for Autopay or Mobile Pay service.

Personal details
Name of applicant Mr./Ms./Mrs. or Company:

Mobile Contact Number: Email:

• Your mobile number will be used for all your future communications at etisalat.ae. In case you lose your password, we will send an SMS to
your mobile number

1. Customer registration details 4. Payment and recharge details

A) Bill payment
New user
• Details below will be used to create an online profile which
• Provide your accounts and payment option details
will allow you to transact online at www.etisalat.ae/online • For fixed amount, specify the payment amount
Activate Mobile Payment Options
User Name: Account No. Pay
Outstanding Amount
Fixed
Yes/No Amount AED
1st choice
2nd choice
3rd choice
• User name can be alphanumeric characters
( A-Z or 0-9 ) (6 to 8 characters/numbers)
Your Account Number that you wish to register at Etisalat B) Wasel recharge and renewal
Online Services: • Recharge date should be in format DD-MM
• (Mobile number/landline number/Internet user ID ) • Recharge day should be Sat, Sun, Mon, Tue, Wed, Thu, Fri
• Minimum amount for Wasel recharge is AED 50
Security question
Recharge Option
• To choose your preferred secret question, please tick the box Activate
Activate Weekly Amount Monthly Amount Auto
• This question will help you retrieve your password if you Account No. Mobile Pay Renewal
Yes/No Facility
forget it Amount Recharge Amount Recharge Date
AED Day AED ( DD-MM ) Yes/ No
Favourite movie Favourite car
/
Favourite city Favourite sports team
Mother’s middle name High school name /
/
Answer:
/
Existing user
Please provide your user name at Etisalat Online Services 5. Your authorisation
User Name I/We have read and agree to the “Terms and Conditions”.

2. Request details Signature Company stamp (if required)

Date: _________________
Choose your request type:
New Autopay/Mobile Pay request 6. Required documents
Amend existing Autopay/Mobile Pay request All category of consumers should give a copy of their credit card to avail
this service.
3. Credit card details GCC National
UAE National
Credit card type: Visa MasterCard • Valid passport and a true
• Valid passport and a true copy copy of stay in the UAE
Credit card number:
thereof or any other
Expiry date (MM-YY): / Expatriates
valid identification
• Valid visa and passport

For our use only

Mobile Contact No.: __________________________________ S/O No.: ______________________________________
Remarks: ___________________________________________
Staff Name: _________________________________________ Employee No.: _________________________________
Signature: __________________________________________
 Terms and Conditions
autopay and mobile pay services

1. These Terms and Conditions between you and Etisalat, 5. We may cancel this Autopay arrangement at any time. This
together with your Autopay/Mobile Pay Application Form, may occur, for example, in the instance of dishonoured
establish the terms and conditions of your Autopay/Mobile or rejected payments, repeat suspensions or if we have
Pay arrangement to a credit card. By completing the Autopay/ reasonable suspicion that fraudulent information has been
Mobile Pay Form you authorise us to charge your credit card provided in relation to your arrangement. In such an event
in one of the following ways: you will receive notice from us in writing and an alternate
1.1 Bill Payment method of payment must then be arranged. If we cancel this
• By selecting Outstanding Amount option, you authorise us arrangement for any other reason, you will receive notice
to charge all amounts payable in relation to the Etisalat from us in writing 30 days prior to the cancellation.
accounts you nominate to the credit card on the due date
of the bill 6. Etisalat reserves the right to change, amend or reproduce these
Terms and Conditions or any document related to Autopay/
• By selecting Fixed Amount option, you authorise us to Mobile Pay service from time to time as it may deem fit. Any
charge a fixed monthly amount as specified by you to the such change, amendment or reproduction shall immediately
credit card bind the Customer from the date on which it is posted on the
Etisalat website at www.etisalat.ae/online.
1.2 Wasel Recharge
• By selecting Monthly option, you authorise us to charge a 7. All correspondence relating to this arrangement will be
fixed monthly amount as specified by you to the credit card forwarded to the address of the Etisalat account holder.

• By selecting Weekly option, you authorise us to charge
a fixed weekly amount as specified by you to the
credit card
1.3 Wasel Renewal
• By selecting Renewal option, you authorise us to charge
the renewal amount to the credit card
1.4 Mobile Pay service
• By using Mobile Pay service, the amount will be debited
from your registered credit card with us
8. We are committed to the protection of your personal
information. Any information provided to us will remain
confidential in accordance with applicable laws and
regulations. Your account information will be dealt
in accordance with applicable laws and the Etisalat
Privacy Policy as amended from time to time, found at
www.etisalat.ae. Etisalat may use and disclose your account
information to your credit card issuer to verify the credit card
details that you provide us, in order to process your payment
and to investigate any possible incorrect payments.

2. If the due date of your bill or your Autopay Fixed Payment

falls on a Public Holiday or non-business day, the payment
will take place on the next business day.

3. It is your responsibility to ensure that you have sufficient

available credit in your account to honour the payment.
Please advise us at least 3 business days prior to the due date
shown on your bill of any changes to your credit card details
including account number, type and expiry date. If you do not
do this, your payment may be dishonoured.

4. If you have a dispute regarding your Autopay arrangement or

want to alter or cancel this arrangement, or stop or defer a
specific payment, please contact us at least 3 business days
prior to the due date of your payment.