SafetyNet — Activation

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Agent Sign-In

Enter your username and password, then scan your face.

Username or RAD ID Password

Current password

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Password verified — scan your face to finish signing in.

Agent PIN Admin password (if not signed in on this device)

Licensed OSS/BSS platform · Monarch Solutions LLC

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Yellow — Caution: check with your lead before enrolling.

Red — Hold: do not enroll here — contact your lead.

Finish Federal

CA-approved customers who still need the federal step

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Your applications — today

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Activate SIM

Customer is approved by California. Scan or enter the SIM ICCID you're handing them.

This application still has outstanding NLAD requirements.

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Is the customer receiving a device?

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SIM / ICCID

Device ID / IMEI Not Required

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1 · Customer selfie

Customer selfie (required)

This is a customer selfie capture. Please face the camera towards the customer and tap capture. A 5 second countdown will appear. Ensure the applicant is in the frame at countdown end. Review captured photo for details.

2 · Applicant

First name

Last name

Date of birth Last 4 of SSN Mobile phone (optional — leave blank if none) Email (required) Best way to reach Service street address

Apt / Unit (optional)

City

State

ZIP

3 · Eligibility

How does the customer qualify?

Qualifying program

Medicaid / Medi-Cal Subscriber ID (14 characters, e.g. 93936225A35227)

Household income ($/yr)

Household size

Qualifies if income is at or below 135% of the Federal Poverty Guideline for the household size.

Customer lives on Tribal lands (FCC §54.400(e))

Qualifying through a child/dependent (Benefit Qualifying Person)

BQP first name

BQP last name

BQP date of birth

BQP last 4 SSN

Current LifeLine provider (transfer)

This customer is already on CA LifeLine with another provider — select it to transfer the benefit. Wrong provider = 24-hour lockout.

4 · Disclosures, Consents & Certifications

Lifeline Disclosures. Lifeline is a federal benefit (FCC) providing discounts on broadband and/or voice service. Providing false information to obtain the benefit can result in fines, imprisonment, de-enrollment, or being barred from the program.

One Benefit Per Household. Only one Lifeline benefit is allowed per household — individuals at the same address sharing income and expenses. Receiving benefits from multiple providers violates FCC rules and results in de-enrollment. The benefit is non-transferable to another household or person.

Eligibility & Verification. Eligibility is determined via the National Verifier / NLAD or FCC-approved alternatives administered by USAC (888-224-3213, usac.org/lifeline).

Terms. By submitting, the applicant agrees to SafetyNet's Terms, Acceptable Use and Privacy policies at safetynetwireless.com/terms/. Assigning a telephone number constitutes "activating the service" per 47 CFR §54.407(c)(1).

I consent to use of this electronic form; I may request a paper copy or enroll by phone (1-844-946-6768), and may withdraw consent before activation.

I authorize SafetyNet & partners to collect, use, share, and retain my personal information for Lifeline eligibility, enrollment, and compliance, including sharing with USAC. Denial of consent = denial of benefits.

I consent to be contacted by phone, text, email or mail for processing and marketing (auto/prerecorded incl.). Marketing consent is optional; reply STOP to opt out. Msg/data rates may apply.

Consent to Transfer California LifeLine Benefit

I currently receive a California LifeLine benefit.

I understand that I cannot have multiple LifeLine Program benefits with the same or different California LifeLine Service Providers.

I want to transfer my California LifeLine benefit to SafetyNet Wireless.

I understand that if my California LifeLine benefit is transferred my LifeLine service with my current California LifeLine Service Provider will immediately end. If my current California LifeLine Service Provider provides me a landline telephone service, I understand that the California LifeLine discount will immediately end for the telephone service I received from that Service Provider.

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 SafetyNet Wireless, my new Service Provider.

Transfer consent: I knowingly and voluntarily authorize transferring my CA LifeLine benefit to SafetyNet Wireless; my prior provider's LifeLine service/discount will immediately end and I may be charged full rates if I keep using them.

Certifications — under penalty of perjury, I certify:
• I meet Lifeline's income- or program-based eligibility (47 CFR §54.409).
• I will notify SafetyNet within 30 days if I no longer qualify or my household gets more than one benefit.
• If Tribal, I live on Tribal lands (47 CFR §54.400(e)).
• If I move, I'll provide my new address within 30 days.
• My household will receive only one Lifeline service and isn't already receiving one.
• The information provided is true and correct; false statements are punishable by law.
• I may be required to re-certify and failure to do so results in de-enrollment (47 CFR §54.405(e)(4)).

I have read and certify all of the above under penalty of perjury.

Applicant signature

✔ Signature captured

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5 · Verify & Submit

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Photo of customer ID (required)

I confirm this applicant recently moved to this address or is a separate household.

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