Monarch MVP | SafetyNet

Lifeline Enrollment

Application Form & Agreement

Information Regarding Your Lifeline Service with Monarch MVP

Providing accurate information is critical, as false or incorrect details may affect your eligibility and result in your application being rejected by the National Verifier.

By selecting Monarch MVP for Lifeline service, you agree to a 180-day commitment. If you terminate or transfer service before the end of this period, you will be responsible for the cost of the device provided. The device price is listed next to the "No Commitment" option.
If you transfer to another provider during the 180-day commitment period and do not return to Monarch MVP by the end of the same month, you will be charged a prorated cost for the device based on the months of service completed with Monarch MVP.
You may cancel your service at any time by contacting Monarch MVP Customer Support at +1 (844) 946-6768 or info@monarchmvp.com. Canceling service during the 180-day commitment period will result in responsibility for the device cost as outlined above.
By proceeding, you agree to the "Upgrade Devices Terms and Conditions," and your electronic signature confirms your acceptance of these terms.

LifeLine Application

Lifeline Eligibility Criteria and Electronically Initialed Certifications

You can qualify for LifeLine if you or another person in your household is enrolled in any one of these qualifying public assistance programs:

First Name *

Middle Name

Last Name *

Date of Birth *

Last 4 Digits of SSN *

Email *

Phone *

What is the best way to reach you?*

Email Phone Text Message Mail

Please enter your Mobile/Device IMEI Number (Dial *#06# on your phone to get IMEI, This works for most phones)

Benefit Qualifying Person (BQP): Check if you are qualifying through a child or dependent in your household. Once Checked, please enter the child/dpendent details.

First Name *

Middle Name

Last Name

Date of Birth *

Last 4 Digits of SSN *

My residential address is * Temporary Permanent

Check here if you live on Tribal lands.

Residence Address * (Home Address Only, No office Address)

APT/Floor/Other

City *

State *

Zip *

My Shipping address is different

Shipping Address *

Shipping APT/Floor/Other

Shipping City *

Shipping State *

Shipping Zip *

Receving California LifeLine benefit with another Service Providers? if so you can transfer with Monarch

I consent to the use of this electronic form and understand I can request a paper copy of terms, associated fees, or enroll using non-electronic methods by calling 1-844-946-6768. This consent may be withdrawn at any time before service activation.

I authorize Monarch MVP, SafetyNet, and their partners to collect, use, share, and retain my personal information, including details required for Lifeline eligibility, enrollment, and compliance. This information may be shared with USAC for program administration. I understand that failure to provide consent will result in denial of Lifeline benefits and service.

I consent to be contacted by Monarch MVP via email, phone, text message, or mail for application processing and marketing purposes, including through automated systems or prerecorded messages. Consent for marketing is not required for service and can be revoked anytime by replying "STOP" to a text, unsubscribing from an email, or calling 1-844-946-6768.

Standard message and data rates may apply, and message frequency may vary. Reply "HELP" for assistance or see full details in the Terms and Conditions and Privacy Policy at https://lifeline.monarchmvp.com/terms.php.

Lifeline Disclosures, Consents and Certifications

Lifeline is a government benefit program from the Federal Communications Commission (FCC) providing discounts on broadband and/or voice services. Providing false information to obtain this 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. A household is defined as individuals living at the same address and sharing income and expenses. Receiving Lifeline benefits from multiple providers is a violation of FCC rules and will result in de-enrollment. Lifeline benefits cannot be transferred to another household or person.
Eligibility and Verification: Eligibility for Lifeline is determined through the National Verifier, National Lifeline Accountability Database, or FCC-approved alternatives administered by the Universal Service Administrative Company (USAC). For more information, call 888-224-3213 or visit usac.org/lifeline.
Terms and Conditions: By submitting your application, you agree to SafetyNet’s Terms and Conditions, including Acceptable Use and Privacy Policies, available at safetynetwireless.com. The completion of a service application and being assigned a telephone number is described as “[activating] the service,” in accordance with 47 CRF § 54.407 (c)(1).

Certifications

By continuing, you acknowledge the following under penalty of perjury:

I meet Lifeline's income-based or program-based eligibility criteria per FCC rule 47 C.F.R. § 54.409.
I will notify SafetyNet within 30 days if I no longer qualify for Lifeline or if my household receives more than one Lifeline benefit.
If I qualify as a Tribal resident, I live on Tribal lands as defined in FCC rule 47 C.F.R. § 54.400(e).
If I move, I will provide my updated address to SafetyNet within 30 days.
My household will receive only one Lifeline service, and, to the best of my knowledge, it is not already receiving one.
The information provided is true and correct, and I understand false statements are punishable by law.
I understand I may be required to re-certify my eligibility at any time, and failure to do so will result in de-enrollment as per FCC rule 47 C.F.R. § 54.405(e)(4).

Benefit Transfer Consents

If I am transferring my Lifeline benefit from another provider to SafetyNet:

I understand my benefit will be applied to SafetyNet services and will no longer be applied to my previous provider.
I may lose service or be charged full rates by my former provider if I continue using their services after the transfer.

By signing below, I certify that I have read, understand, and consent to the disclosures, certifications, and terms outlined above for enrolling in Lifeline with SafetyNet.

Applicant's Signature

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