BHARAT SANCHAR NIGAM LIMITED O/o GENERAL MANAGER TELECOM, AMRITSAR i Application for service [Please tick (V) appropriate © Landline Landline No. © Broadband Landline No. © CDMA CDMA No. © Mobile Mobile No. © WiMax WiMax Account No., ee "or: Address: © Service to open: Eg. STD, ISD, Call Waiting, Call Transfer, etc © Service to close: Eg. Broadband, STD, ISD, Call Waiting, Call Transfer, etc © New Plan to opt: © Permanent Closure: © Moving to some other City. © Being and additional phone, not required. © Death of original applicant. © Financial constrains. © Closure of Business. ° ° ° ° Taking mobile connection from BSNL in place of Landline. Taking Mobile/Landline telephone from other company. Billing problem Frequent faults © Other reason. ee en ee A | agree to pay the prescribed charges, if any. Signature of Customer/Authorized Signatory Contact No, Dated ie NG aCe eee Email: Processed by FREE versionjof