Walesi Application Form

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.

TYPE

SECTION A. PERSONAL INFORMATION

SECTION B. IDENTIFICATION

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.

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

Note: annual income before tax & FNPF deductions

Note: annual income before tax & FNPF deductions

Note: annual income before tax & FNPF deductions

Note: annual income before tax & FNPF deductions

Note: annual income before tax & FNPF deductions

Note: annual income before tax & FNPF deductions

SECTION D. PLACE OF INSTALLATION

SECTION E. DECLARATION

(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