Customer Engagement Form- POSTPAID

Paste you self

TelecomCircle - Delhi attested passport
size photograph
Please fill this engagement formin capital letters with black ink. Fields marked in Red are complusory

CEF No. - Activation date

Donot Staple
Product Type: Mobile Blackberry Data Card Others:
SubscriptionDetails
Aircel No.
SimNo.
Title Mr. Mrs. Ms. Gender M F Age: Date of Birth
Name
Father's/Mother's/
Husband's Name
Nationality: Marital Status Married Sing
If you are a FOREIGN NATIONAL, please fill passport No.
CompanyName:
(For COCP
Present Address:
(Address for verification
and Billing)
City/Village:
Nearest Landmark: District:
State: Pin Code Alternate no:
Permanent Address:
(Supported by
Documentary Proofs) City/Village:
Nearest Landmark: District:
State: Pin Code Alternate no:
Email:
PAN/GIRNo. Please fill up form60 or 61(whichever is applicable) given below in case you do not have PAN/GIR No.
If you wish to register your connection for NDNC (National Do Not Call), please send SMS <START NDNC>to 1909 or call at 1909
ForCompanyOwnedconnections (Please providedetails)
Name of Authorized
Signatory Designation:
e mail ID: TelephoneNo:
DocumentaryProofs
P roof of Identity
(P OI) POI No. :
P roof of Address
(P OA) POANo. :
Employment P roof
(For corporate only)
FORM 60 FORM 61
i) Details of Transaction: ii) Amount of Transaction: Details of Documents being produced in support of address
iii) Are you assessed to Tax: Y ES/NO If Y es, I hereby declare that mny source of income is from agriculture and I am not
a) Details of ward/circle/range where the last return of income tax filed required to pay income tax on any other income if any,
b) Reasons for not having PAN or GIR No. Signature of the Declarant
OutstationSubscriber / ForeignNational (provide detailsoflocal reference)
MyLocal reference and address is:

State: Pin Code: Local No: 1) 2) 3)

TariffPlan, SchemesandPayment Details
Bill Plan Name: ServicerequestedandDeposit (B)
Payment Details ISD STD National Roaming International Roaming CLIP
Enrollment Fee: (A) Others, if any:
Deposit (B) Service Deposit:
Grand Total (A+B) Subscription deposit:
Mode of Payment: Cash Cheque Card DD Total Deposit:
Cheque/DDDetails: Bank name: Card Details:
Cheque to be made in favor of "Aircel Limited"
Declaration
I/We declare and undertake that the above information provided by me/us is true and correct in all respects. I also undertake the responsibility for the correctness and genuineness of the documents
submitted by me/us in regard to the Aircel Postpaid mobile subscription. I/we have read and fully understood the termand conditions mentioned overleaf and unconditionally accept themas binding on
me/us. I/We have understood all the rates, tariffs and other related conditions at which telecommunication service will be provided inside and outside India as applicable as on this date and as amended
fromtime to time. I/We undertake that in the event this connection is used for any telemarketing purpose I /We shall be solely responsible for registration of the connection with the mandated statutory
authorities.
Date: Signature of the customer/Authorized signatory along with seal
To be filled by Retailer To be filled by Distributor
I/We hereby undertake and confirmthat I/We have seen the customer and certify that (a)
Regional
C ustom
The/ Registered Office:
Office
er
Aircel Limited
Urban Rural
Aircel CEF has been duly filledPlot
andNo.
signed
2 & 3,by applicant
Local only
Shopping in my presence;
complex, (b) The
Sector B, Pocket photograph
1, Vasant Kunj, New Delhi –I/We
110070 / 5th Floor,
confirm thatSpencer Plaza, 769,docum
all the necessary Anna Salai,
entaryChennai-6000002
proof, signature and photograph of the applicant
Delhi Post-paid Customer Care No, - 9716012345 or 121 (from Aircel Mobile). Customer care email address: care.del@aircel.co.in. Website: www.aircel.com
submitted has been matched with the applicant; (c) The Identity and address submitted are are in order and I/we are activating the SIM card after the verification of the details provided in the
verified with the respective originals and are true; (d) Details mentioned on the CEF match with engagement formwith the supporting documents