MTNL New Tel Conn_english

8/3/2019 MTNL New Tel Conn_english

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MAHANAGAR TELEPHONE NIGAM LTDJeevan Bharati Bldg. - Tower 1, 12th floor, 124 Connaught Circus, New Delhi - 110001Web Site Address: http://www.mtnl.netin

Stampsize

Photograph(self signed)

*1.Type of service requiredPlease tick (v")*2. Type of applicant : _

TITLE

:ISDN

DOLPHINTRUMp

. . . . . - .CIII.LANOLINE MOBILE I POSTPAID PREPAID I

FWP I POSTPAID PREPAID I

SURNAME FIRST MIDDLE*3. Name 1 " , 1 . ' 1 . ' 0, I*4. Father's/Husband's Name*5. Date of Birth (D D /MMIYY) 1 1 1 1 I ' 1 1

(Date ofincorporation incase of company)

1 1 1 I I I I I I II 1 1 I I I I I 1 I I 1 I*6.Sex M/F D *7. Nationality I11. Average income per month (Rs) a) < 10,000 o 1 Single I Marriedlc) 20,000 - 30,000 0*8. Hobbies ---- *9. Education 10.MaritalStatusb) 10,000-20,000 D

d) 30,000 -50,000 0 e) > 50,000 0*12.ResidentiaIAddressl ~

Installation Address13. E-mail id:_______ ~ PINCODE14. Billing Address(If different from above)Local Address (Foroutstation customers)*15.A) PAN NO.JGIR NO. L - L I _ I L - ' - - . . J ' - - . . J I L l 1 L - 'L - 'L - ' - - - - , - - - - , - - - - , - - - - , I - - , 1If PAN No. not available please fill form 60)16. Existing MTNL Tel No. (if any) I I I I 1 Existing Customer AlC No. 1 I 1 I I I17. i) Type of any other service of MTNL or other Operator used by you _ii) TelNoof that service a) I I 1 I I I I I I 1 1 b) I I 1 1 I I I I I I 1 I*18.Tariff Plan opted: Service (1) _ Tariff Code UTI Service (2) Tariff Code

Tariff Code ITD Service(4) TariffCodeervice (3) _*19. Option for Receiving Bill _*20. Option for Bill Payment _ *21.Type & Model No of handsetiTelephone instrument/Modem required _*22. Any additional Value added services required ~23. NDNC Option: I Yesl ~*24.Type of Identity proof submitted & its No.: L-L--'---'---'---'---'---'---'---'---'---'---'---'---'*25. Mode of payment for Registration: (EMI I Down Payment) Cash I Cheque I DO Rs. _Credit/Debit/Cheque/DD No. ---;_ Date: _Bank account no. Name of Bank & Branch on which Cheque I DO drawn _(incase ofcheque)* Columns are mandatory. \

Iooked ByName of CSC IDistribu;.to~r:-./:.M;::B:::A~:=;::=;==;=~~~=;:=;:=;=;=;_CSC IDistributor CodeCustomer Alc Number 1 I COMA Handset Model

I Iandline IMobile No. ICOMA SIM No .1 ESN No.--------------------------------------------------------------------------------------Tear here --------------------------------------------------------------------------------

Received an application form for service from with the paymentof Rs. in Cash I through Cheque I DO I Credit I Debit cardsSignature & Name of MTNL officer with stamp _ Date: _


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CUSTOMER DECLARATION / .uNDERTAKING:I hereby declare and undertake that the above information is wholly true. I have read and understood the instructions and the terms &conditions of MTNL for this service and agree to abide by them. I have gone through the details of the tariffplan, which I have optedfor, which I know, can change from time to time. I also agree that my connection is subject to verification, evaluation and acceptancebyMTNL.

* Signature ofSubscriber _(Signature, name & seal of Authorized Signatory in case ofCompany)

* Received SIMlHandset* Customer's Signature _*Date:

Customer GuideAt SI. No 2 fill up type of applicant i.e. individual -- General (Gallantry I President's Police Medal for Gallantry awardees, Warwidows, Disabled soldiers, Blind, Serving DOT employees, Retired DOT or MTNL or BSNL employees, Senior Citizen), NonResidential telephone in Schools IUniversities I Institutions I Homes for Aged IOrphans etc recognized by Government, a Private orPublic Company, Sole Proprietor orPartnership firm.At S1.No 12 fill up' tile Adress where fixed connection is to be installed and I or where customer normally resides in case of mobileconnection. Customer has to submit proof of address for it.At SI. No 14 fill up the address where you want to receive the bill of the service. It is to be filledonly ifinstallation address isdifferentfrom billing address.At SI. No 16mention existing telephone IMobile number &Customer Account No. ofMTNL, on which you want toget extra servicelikeBroadband, internet or other Value added service etc.At S1.No 18please fill up Tariff plan orTariffcode asgiven in our booklet for the service you want toavail. We have many alternativetariff plans to suit indi1vidualrequirement. .At SI. No 19Option tor Receiving Bill: Ifcustomerwants to receive the bill through e-inail write bill through e-mail else leave it blank.Kindly giveyouremail address at serial No 13.At S1.No 20: Option for bill payment: If customer wants to pay the bill electronically please specify the mode of bill payment i.e.through ECS/Credit/Debit card. Thetotal discount on both e-billing and e-payment combined together will not exceed more than Rs.250. .At Sl.No 21 Please fill up type I model of handset I telephone instrument I modem I setup box required by you. Details of availablehandset are given inMTNL brochure.At SI. No 22 Please fill up details of any additional or value added service you want toavail like ISD I STD I extra email ids I extra e-mail space I internet I STD roaming IISDroaming I CURl VMS IGPRS IMMS IVideo Conferencing/ Games on Demand IVideo onDemand I Fixed IPaddresses ICall forwarding IAbbreviated dialing ICLIP I any other. The details ofvalue added addresses are giveninMTNL brochure.,At SI.No23 indicate your option forNational DoNot Call registry (NDNC).At S1.No 25 for payment option you want to choose i.e. Down payment IEM! ICredit card IOnline payment

Instructions(a) Please furnish the original documents with photocopies for verification of identity 'and address by one or more of the followingdocuments as applicable: (i)Income Tax PAN card (ii) Passport (iii) Voter LD. card (iv) Driving License (v) Armed License (vi) anyphoto identity cards issued by a Statutory IGovernmentAuthority.

(b) Public Limited Coso may enclose certificate of Incorporation, Memorandum of Articles, duly signed by M.D. I Director of thecompany along with any proof of identity.as .above of the authorized officer of the company. In case application is signed by anauthorized signatory, then attested photocopy ofPower ofAttorney must be attached.

(c) In case of'Govt. oflndia Undertaking, Govt. ofIndia Offices I State GOVLOffices, the aforesaid requirements are dispensed with self-certification on the letter head will suffice along with the name and designation of the coordinating officer to be consulted in case ofneed.

(d) in case of Foreign Missions in India and other foreign agencies, the name and designation of the authorized officer along with details ofofticials etc. for whOl~the connection is intended.(e) in case of outstation subscribers, details oflocal reference(s) IAddress be given atColumn (14) Billing Address I Local Address to be

given.(f) Payment will be accepted by cashl DD/pay order in favor of "MTNLMumblli, Dolphin" for GSM services and "MTNLMumblli"

for any other service. . .(g) For availing telephone under concessional category, requisite documentary proof has to be submitted along with application. Contact

our customer care executive orToll Free Helpline or website formore detail.For more' details or any help visit our website http://mumbai.mtnl.net.in or Dial our Helpline

I Dial I .1503 . i I iW l~ I Dial I1502 I illiil~ i ~TH!..WnIMII ~SeoWIifu il~tMTNL TRUSTUNEwe CUTIn DIGITAl SIGNS


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FORM NO . 60(See third proviso to rul e 1148)

2 2 - 0 C T 2 0 1 0 1 5 : 0 5 A G M (M M 1 ) 2 4 7 0 7 9 0 0

-wFcttt : of D ecla rat ion to be filed by a person wh o d oe s not have either iii Permanent Account N w ,1 J g E ll ' IGoners /index Re,g iste r num ber and wh o ma ke s p aymen t In cash In tespeo: of trans(fct/on SPIWI~QIcteuses (8) to th) of rute 1148.' ;;;:

' "" "1.. Full Name and address of the declarant 3:;;l.." " "". "." " ,.".''' ''''.'''.''.~'~ '' ''' ''., . . ''.,''''' ~ '.'"" ",. ,... " ......... ' ,'.' . ," ... ' . ,., 'I ~'".,.".".".'.'."'.".""."II ,'.'".,r'.'.'., ................ ..... , . . " ." . , . , , . " ~ , _ t '

,. . , """ . . ,,, ,, ''''. . ,' . . ' ',, ,,. . ,,, ,, , , " "." .2. Partlcula rs of transaction3. Amount of the transaction4. Are you assessed to tax? Yas I No5. If yes,

(i) Details of Ward / Circle / Range where the last re tu rn of Income was filed?(ii) aeaeons tor not having Permanent Account Number I GenM~I.lndex R eg laxer N umber ?

6. Dstails of ',:hedocument baing produced In support of address i n co lumn (1). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , , , .

Verification~I, do hereby decla re th at wha t is s t a t e l c l abc:

is tru~, to the bast Ii! my know ledge and belief.Vetiliedicday, the day of (M.onth), 2001.Date: .Pla ice : .

tnsuuciio ns : Documents which can ba produced in support 01 the address are :-(a ) Ration Car~(b) Passport(c) Driving Licence(d) Identity Card issued by a ny Inatltutlon(e) Copy of the e lo ctric ity b ill o r telephone bill Show ing res iden ti a l address(f) Any document or communication Issued by any authority of Central Governmen

State Government or local bodies showing residential address(g) . Any other documenta ry evidence In s up po rt o f the address given In the d eG I(; I~~C

"


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t '

~ ~ f ? n r / For Individual Customer

'~ ~I~ 1'1f1T(~ ~ ~ ~ ~ )/ SPECIMEN SIGNATURE (FOR CUSTOMER SERVICES CENTRE)en ) ~ C j 7 J ~ r a) Name of the Company

. ', :i - ' : ., , ;. ", :. "XQ ) ~ w . / b) Consumer No.l' rY;' \ ; ,';''1 ) c j - v f ) C f ) , < 0 1 c t T ~ / c) Date of Registration

" '.. '

cr) ~J l l f ) 11 - ; o f . / d) Telephone No, _n n n __ n_n n _3 1 ') C f )l l li ~ ~ 1 'ft.q ~ / Work Order No. & Date n nnu " _

(XQ ,T f,c r,~ ~ C f ) l l lT C ' l l l ~ ~ ~ ~ ) / b,c,d,& e for office use only)'E f ) ~ ~ ~&'R / Signature of Applicant

~ m WTlT/ to be signed at the time of ------------------------------------application With Rubber Stamp ------------------------------------

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - q o . c ~ ~ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -~&'R 1'1f1Tc j vn C f ) ' < 0 1 ~ WTlT~ ' C f 5 1 Km ~)

SPECIMEN SIGNATURES (to be given to customer at the time of registration~c1 "Il :h l1 m~ mR ~ C !J " ic lC!1C !C 'l c iJB ill -n - c p T qp :m ~ Km ~ ITo be given back to MTNL Staff at the time of Installation of phone

-$ ) ~ ' C f ) T '1 T l1 / a) Name of the CompanyXQ ) lJ I6C I? W . / b) Consumer No.1J) ~ Y . f l , C f ) , < O J c t T ~ / c) Date of Registrationcr) ~ . f f l t f l I 1 : t o / d) Telephone No.! ,".f.' !" ":',3r) = C f ) T T ll l l - B T ~ " ' t I T ~ 1ft. q ~ / e) ,Work Order No. & Date uu __ n n n _

(XQ,Tf,cr,~ ~ C f) l l l f C 'l ll ~ ~ ~ f ? n r ) / b,c,d, & e for office use only)'E f ) ~ ~ ~&'R / Si'gnature of Applicant

~ mWTlT I to be signed at the time ofapplication With Rubber Stamp

. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

1 t , ~ / ~ / ~ , - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - -- - - - - - -~ ~ - - - - - - - - - - - - - - - - - - - - - ~ ~ - - - _ ~ _ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

" 1N ~ C '1 "1 l f ) 11Cf)~(ftI'1 ~ ~ ~ f c l ? < n % I1 t, P I I5(j 1g : c f Q R I $1 11 ~ / ~ ~ f c p < : f f i ~ C '1 1 l f ) 1 1m 'C fl"X ~ ~ ~ ~ %I, Shri/Smt./Ku .~-------------------------------------------- --------------- have applied for aTelephone connection to have installed at address -----------"----------.------------~------- - - - - - - - - - - - - - - - - ~ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - . - - - - - - - - - - - - - -I affirrn that the telephone is for my bonafide use,

,.,' " . ",, I

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~ / ~ ~ ~ f u " g / For Company/ Firm etc.: - - . ~ m ~ ( ~ x t c r r ~ ~ f u " g ) / SPECIMEN SIGNATURE (FOR CUSTOMER SERVICES CENTRE)

c p ) ~ e m ~ / a) Name of the Company . --------------------------.----------~)',!~.'"'I~~~.' b) Consumer No, , nn n __ n __ nn n

. 'i -- -. '; j''1 ) c j V 1 ' ' j c f ) ~ 0 1 c t T ~ / c) Date of Registration n nn_ ---------------- n __ n_tl") 0 ; c > f i C f ) l ' i 1'./ d) Telephone No. nn _3 1 ) C f l l l l h ~ ~ 1 T - f . c r ~ / Work Order No, & Date , ~----n----------------

("&,'1,tl",~ ~ C f l l l l T ( > l l l ~ ~ ~ ~ ) / b,c,d,& e for office use only)'Ci) ~ ~ 6f(ffm / Signature of Applicant .~ m " f l1 1 < T / to be signed at the time of ------------------------------------

application With Rubber Stamp ------------------------------------- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - q J C ~ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -~w ~ ( c j G 1 1 C f l ~ O I ~ ~ ~ e m ~ ~ )

SPECIMEN SIGNATURES (to be given to customer at the time of registration l C f l B i ll x l C f l l C TNff ~ ~ ~ ITo be given' back to MTNL Staff at the time of Installation of phone

1 ( >1bl."--

c p ) c i 5 t A T c n r r r J 1 1 / a) Name of the CompanyX 'Q ) ~ T I J , / b) Consumer No,'1 ) c j G 1 1 C f l ~ 0 1 c B 1 ~ / c) Date of Registration

, , t l ) 'e 81 ~ ) 'i " - ; f . /d) Telephone No,,:/' ~.'3 () $ l l l ( 8 ~ 1 T -f, c r ~ / e) Y'\4orkOrder No, & Date n n nn _,,("&,'1,tl",~~ C f l l l l T ( > ll l ~ ~ ~ ~ ) / b,c,d, & e for office use only)'Ci) ~ ~ ~ffi / SLgnature of Applicant~ m x = r P J / to be signed at the time ofapplication With Rubber Stamp . ------------------------------------

I _

- 4 , m / ~ / ~ , - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ~ - - - - - - - - (tj'j1=f/~ ~ c n r ~ )n n n __~-------------------------------n------ c n r C f lB il l f l / ~ / P l 8 ~ I C f l Q d ~ ! : i I '1 1 w = r r f U r c tC 1 J T c ' I T ~ f c p 0 ; < : > nC f ) l ' i ~ c j V i l C f l ' 1 'O I C ' f 2 J T ~ ( ' Q C l T ) - _ _ n - - n - - - -- - ---- -- - - -- - _n - -- - n - --- - - - - n_n -- n_

\ lR m~ ~ ~ ~ ~ ~ / ~ c t T 3f f i x 1 f c r f t r c r c = r ~ f c R r r Tf(ff ~- 4 ~ ~ . 1 ' I R 1 $ 1 l 'i C f l f [ . ~ . f c n ~ . e C ' 1 l C f ) l' i ~ . ~ ~ ~ ~ ~ II, Shri/Smt.lKu. ;,-------------------------------------------------------- an Employee/Partner/

, Directon of the (Name of time/Company etc.) ---------------------------'----------------~-----"

---_------ -------- -,---:---- --- ---- --- ---------------------------- ---------- ------------~'---- - am dutyauthorised by the firm/company to have the telephone registered & installed at address

i-- -~,~'-~~;~.~.,--~.-';-- ----- ------- -- ----- -- ----- -- ------ ------ --------- ----- -----.~-.:---------------- on .beh~lrof, the Company / Firm etc .

. 'Ifaffirm'that the telephonejs for 'bonatied use of the Cornpany/nrrn~m / Signature ------------------------------