NEPAL TELECOM

(NEPAL DOORSANCHAR COMPANY LIMITED) Please affix a

KATHMANDU REGIONAL DIRECTORATE recent
photograph of
APPLICATION FORM FOR 'IN' SERVICE - FREE PHONE SERVICE yours
Application No:
For Office Use
Regd.No.
Date

1 Status of Customer Individual Business Corporate

Government Professional Others ……………..

2 Name of Office/Firm/Organization (Please Specify)

3 Name of Proprietor/Applicant

4 Address

5 Adress for Correspondence

6 Applicant's Father/Husband's Name:

7 Applicant's Grandfather Name:

8 Name of Contact Person

9 Telephone No.

10 Mobile No.

11 Email Address:

12 Applicant's Identity: Citizenship Passport PAN Others

Number

District:

Declaration: I/We hereby declare that information given above is true to my knowledge & belief and I/We have read and
understood the terms and conditions provided and accept them as binding on me/us. I/We have understood all the terms &
conditions, rate, discounts, usage charge and any other related fees or service charge and related conditions at which Nepal
Telecom Services are provided within/outside Nepal by Nepal Telecom as applicable on date and amended from time to time.

Signed On:
mm/dd/yy

(Signature of Customer/ Authorized Signatory) (Signature of Customer/ Authorized Signatory)

 (Please fill the attached annexure for technical details)

FOR OFFICE USE ONLY

1 Initial Installation Cost

Registraton Charge Rs. 1000/-

Local Rs. 10000/-
Security Deposit
STD Rs. 15000/-
Total No of Branches:

By:
Designation:

2 Service Division

Amount Received
Receipt Number
Date

Verified By:
Designation:

3 Technical Division

Number Allocated
Date of Activation

Activated By:
Designation:

Please Attach Service Flow Node Diagram in new Sheet.

 Technical Details to Free Phone Service
m m d d y y m m d d y y
1 Service Type: Temporary From To

Permanent

2 Default Language Type English Nepali

3 Time limit per call Seconds

4 Call Limit Daily Weekly Monthly (Tick only one)

4.1 Limit by No.of calls Amount Both (Tick only one)

4.2 Limit No. of calls

4.3 Limit Amount Rupees

5 Telephone Information
S.No. Telephone number Forwarding Numbers
1
2
3
4
5
6
7
8
9
6 Routing features
Node No. Node Type Required Node Name
1 Origin call screening Yes No
2 Origin call routing Yes No
3 Time dependent routing Yes No
4 Selection dependent routing Yes No
5 Ratio depedent routing Yes No
6 Cycle dependent routing Yes No
7 Authentication Yes No

7 Announcement list
Anno. No. Announcement text both in english and nepali ID (for office use)

8 Complete Call flow Diagram (Please Attach New Blank Sheet )

(Signature of Customer/ Authorized Signatory)

Company seal (if any)
Date:
 INSTRUCTIONS TO FILL THE APPLICATION FORM

1) Please fill the form with CAPITAL LETTERS.

2) For technical requirements please fill up the attached annexure.

3) Specify all telephone numbers with full STD code.

4) For tariff , Please visit our site www.ntc.net.np.

5) Tariffs are subject to change from time to time.

6) The AFS Number shall be allocated subject to availability.

7) Please use photocopy if you require more sheets.