Student Broadband Package Application Form

Student Information
Name

Mr
FIDA
227

Registration
#
Mobile
#
Home Phone #

MUHAMMAD

03009308721
New
Connection
ajmal.khan_1@yahoo.com

Email Address
Customer Type

Studen
t
15306-4182246-9

NIC #

Package Information
Broadband Phone #

New
Connection

City
Package

1
MB

University Information
University Name
Department
University
City
University Contact Number
Date Of Enrolment

Islamia
University
Peshawar
MANAGMENT
SCIENCES
Peshawar

College

919216515
16-SEP2010
20-JUN2012

Date of Completion

University Verification
Name of Registrar/Dean/Principal/faculty
Signature & Stamp

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Signature of Student

For PTCL Use only

Login Choice 1
Login Choice 2
Login Choice 3

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