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SPSAS Databank Application Form
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Second Name
*
Your answer
Current Address (please include town)
*
Your answer
Postcode
*
Your answer
Phone Number
*
Your answer
Email Address
*
Your answer
Do you already have an 02 Sim Card / O2 number?
*
yes
No
Do you have a Vodafone Sim Card / Number
*
Yes
No
Do you have a Three Sim Card / Number
*
Yes
No
Can you confirm you have a device you can put this data sim into, for example, phone / tablet/ mifi device?
*
Yes
No
Do you need this data for up to 6 months? Please specify how long it is needed for
*
Your answer
Can you confirm that you are from a low income household
*
Your answer
Can you confirm that either you have no or insufficient access to internet at home, no or insufficient access to internet when away from your home or cannot afford your monthly contract or top up
*
I have none or insufficient access to internet at home
I have none or insufficient access to internet away from my home
I cannot afford my monthly contract or to keep topped up for datqa
Do you have a preference depending on your signal area to which network we provide you data with? (please note there maybe a waiting time depending on which network you choose and if we have the sims available as we have to order these a month in advance)
*
02
Vodafone
Three
Is there anything else you would like us to know?
*
Your answer
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