[On customer letter head]

Corporate Periodic User Verification Form

Reliance Jio (Mobile & Other Services)

Date of Verification …………………………

(To be filled in with all details and the same has to be signed by the Authorized Signatory)

Sr. DESCRIPTION Details

1 Circle/State Name UTTAR PRADESH(WEST)
2 Name of Company having bulk connections Darp Shri
3 Number of Connections taken* 21
4 Location ID 9280007825
5 Name of the Authorized Signatory Abhijeet Srivastava

*details of mobile numbers to be attached & verified by the customers as per enclosed Annexure -1

Cu Customer undertaking (Please select in case of NO change in user details – No Annexure Required)

I hereby confirm that there has been no user Name change in any of the mobile numbers (as per count Mentioned above) in last three
months.

I further undertake to inform you of any change in the user name within a week of such change.

C Customer undertaking (Please select in case of Change in user details – Details to be annexed)

I hereby confirm that there has been user Name change/Name transfer happened for below mentioned Mobile numbers for which the
details are enclosed, as per Annexure-A. Please note and update your records accordingly.

I further undertake to inform you of any change in the user name within a week of such change.

Customer Signature (Authorized signatory) Company Seal/Stamp

Annexure A – Details of User Name Change (all pages to be signed and stamped)

Sr. No Mobile Number Old User name Old User designation New User name New User designation

Customer Signature (Authorized signatory) Company Seal/Stamp