= [MAHANAGAR TELEPHONE NIGAM UNITED a Teaone ae ¢Peoe MIM. Mo Doser Mun~ 00028 Gh wearer a GSW27AMCMOSTENZS nae warn iene eee Came: aaa aa == os a fos ae — = se ES = ont ae a MGitscres. | = eee f Sines oe ee aera eee Senses 11.avenge nce pt math 1 «3000 A 19000-20000 zppco-20000 ‘9 dapos~sa00 soso 2 Reaeneaaases) Fons matt aes usar naman (roca bestaeee) esac Te r a as eon Te FHC 1 pargfarependene Aes futon rom see lec aes ronson custome FICO sas.ypnuno. eve i (24 ne an fc 15:8) 65% ner of reps asomes Cort 5 Chaasaeno. (0) 1 Easing MILT Noe) ang ore NeW T oot No r ct 17 Type ofan cer ero ATH orthe Opera wed you er “tt Pan oie: Srv a. tetteote [T Serve 2. ‘reiteade See ‘witeade [1 See Tei coe +12, opsontorsacourg 8 21) Whether us ing vir eed rom NTA x il nhs tape inure eed ore TM, ve i. eter Modo reauted rom HIM vn +2. haya vate abe rvs reins Gece ws tens, IO) 22) Trt Pan fr secon — 23, ONC Oto me eo 4 Tipe dent ae! aomed io ooe soos S| +25: nso oom etin:Cche/00 enema See 0M ewe CO nk Ant. ES RGRSTCAS Gree Sh ren aes (ete otchene) "come remanent camer Satur rooms 1 Aeoked by Name ofS /rbtec/ ag: csc /oentwrcete CII) come Neti: Cece te ss artnet REO MLEDSEMERTSU 1 Aecsivaonapiton om he snmest te incah/taogh ee 700 Site Name of MTRL Ofer tomo ec: Sova hath, ower, 2 er, 124 Commu Coes New B= 110005 ‘bate aren: apf mntin fk: wasoio.eescomasor‘CUSTOMER DECLARATION/ UNDERTAKING: "hereby dele and undertake tat the above formations whol tue {have read nd understood thenstructions andthe tems & conatons of MTL forts services gre to abide by them. have gone UCU the dela of he tari pn, which hve opted or, whieh kw, ‘anchange tom time to time. | ao agree that my connections subject to vercaton evaluation and acceptance by MTNL ead Stondet ‘ean St ‘Signature of Subscibe am (Sanatre name sea of Authorized Signatory ease of Company) Customer ude {1SiNo.2,fitup type applicant India General (Gallary / residen’s Plc Med! or Gallantey awardees, Wr Widows, Diablo sider, ‘ind, Serving DT employees, Retired DoT or MINL 7 SSNL emplojees, Serio Cilzen), Noweslemtal telephoce In. Schook/ Univerites/nsttaton/ Homes fer Agea/Orphans, et recogied by Goverment rate or Pu Company, Sle Propitr or Partership fm, 8 SEZ unt or UN/Embassy. ‘S012 fl up the Adress where tue connecton & tobe rstalled and or where customer noxmally resides incase of mobile connection. ‘Customer Ras to subi proto adres for. "A1SiNo 14 ih up th adress where you want to receive the bllofhe serve, Isto be led ony instalation addres fare om ting ares {TAESINe. 16, anton exstigtlephana/motile umber & customer Aezount No.of MTN on which ou want to get entra serie tke Gradband, Intemetor ther Value Ae Servis, et *pRSiNo.1, plese ill up Tarif Plan r Ta Code as gven nour booklet or the sence you want to aval, We have many ernie Tai Pans to sundial requrervets. *SINo. 39, pton or recavng bls; astomer wat to recahe the bl through el, wt il through eral eee leave blank. Kindy ve your ‘era adress at LN. "AtSito 20, Option fort payment fcntomer wets op the bllclecroicaly, please sect the mode of bil payment trough c3/edi/Dets Car. The ota discount on bth ealing ad e-payment, combined together bl not exceed mare than Rs 25 "ati, 21, pss fa upType/ Mode of Handset /Teleshone mstrucvon/Moaem/SeC-up Gok requred by you. Detail of ovauable Handset are gwen intr brochure ‘A132, past fl up the deta of wy adtionalor ale sevce you want to aval ke 1S0/STD/Estrs eal sentra ama space/nerraySTD ‘oamingSDroaine/CUR/VMS/GPRS/t4W/VideoCorferencng/Games on demard/Video on demand[Fiwe iP Adreses/Call Aorwordng/Atbrevised daling/CUP/any other. he det of Value Added serdces re given a MTNA brochure. AL Slo 23 ingleat your option for National De Net cals Rep (NON), ‘Ata. 25, for payment option you want choose, Le. Down pyenen/EMI/ret carfonline payment. istRUcTONS | (2), Please furnish he orignal documents with photo copes for verison of dent and address by one or more ofthe folowing documents as applicable: come Tx A Cardi) Passport (i Voter cars (Driving Liens (Armed cee (v)Aachar Cr vi) Any ohoto Idenaty cards sued by aStatuion/Govt Author. (@}_ 6) Pub Unted Cor may enclorecarthcae of ncorpration, Memorandum of Atls, duly gnc by M.D, Dacor of the Company ong ‘ith ay roa of deny as above of the authorized officer of the Company. incase appicaion ined by an authorad signatory, tested photocopy of Power of Attorney must be attached. Incase of Enterprise customer under (828 cuore) a copy of GST Regation Cerise tobe provided (The customer has to pay all the charges long wth GS 5 applable| which re charges by MINL forte ence proved by them, (8) Whenever te customer pays exces amount (more than As 1000/- excess than the exces amount wi be cnsiered at Security Deposit bythe customer. {i enever penaty/ate fees due from the customer by MING he same wl attract GST and wile lle in rex bi (c)_ Incave of Gout of nda undertaking, Govt of nda offens/State Gout. oles, he woreda reqarements ae capone with se certifeatons onthe Letter Heh wil aif, log with te nar and designation ofthe co soorcinaing ies to ie conudedin ete of ees (@)_ Incase of Foreign Mision in nda and ater Foreign Agancts, the name of designations of the Authored Officer lng with deta of fleas, ee for whom the connection itendod {e} Incase of eusation subscribers, deta focal reference sadress be gen at Column 1) bling dres/ocal adres to be gen. (f)_Paymestwlbe accepts by esh/DD/Pay Order in favor ot "MTNL Mura, Dolphin” fo GSM Service “RITNL Mumba" for any ether (a). Foravating telephone under concessional category, equ documentary proat has tobe submited slong with appltion. Conte our Customer Care executive or Tol Free Help Une or Webs for mee etl (hy ey Wh connactaty deployed by Subserier ha to be activated oly fe iis registred to cenvazed authentication with TNL. Formore details or ny help vist our Website ia//mtnimumbain or Dil ou HelpLine: 1500 1900223500FORM NO.60 (See third provision to Rule-1148 ) Form of Declaration to be filed by a person who does not have either a Permanent Account Number General index Register number and who makes payment in cash in respect of transaction special clauses (a) to (bof rule 1148. 1. Full Name and address of the dectairant Particulars of transaction Amount ofthe transaction ‘Are you assessed to Tax? Yes / No ifyves, {i) Details of Ward/Circle/Range where the last return of Income was filed ? (il) Reasons for not having Permanent Account Number /General Index Register No. ? 6, Details of the document being produced in support of address in column (1) Verification Gaara es = - do hereby declare that what Is stated above is tue to the best of my knowledge and belief. Verified today, the. day of. (month) 20... Signature of the declairant Date .. Place aan Instructions:- Documents which can be produced in support ofthe address are :- (2) Ration Card (b) Passport. (€) Driving Licence (d) Identity Card issued by any institution (e) Copy of the electricity bill or telephone bill showing residential address (f)_Any document or communication issued by any authority of Central Govemnment/State Government or local bodies showing residential address (6) Any other documentary evidence in support of the address given in the declairant,aia occ / ws on 3 forg/ For Company! Firm etc. -deenare 2pm (ene da doe & fre / SPECIMEN SIGNATURE (FOR CUSTOMER SERVICES CENTRE) ®) byl a aim / a) Name of the Company ® Btw wm. / b) Consumer No. 1) titers aaa / c) Dito of Registration 1) Geflvta a/ d) Telephone No. ‘&) wren a. 7 arta / Work Order No. & Date (eaai.g tact wratera & Guat & fr / b,c,d,8 & for office use only) a) andaes % sem / Signature of Applicant amgea @a wre / to be signed at the time of application With Rubber Stamp ae Ry Bren pT (dofiares & wey ew at feat GT) ‘SPECIMEN SIGNATURES (to be given to customer at the time of registration Sofas siete we we a Meee aN wl ae & fear Sy | To be given back to MTNL Staff at the time of Installation of phone @) Gril wr a / a) Name of the Compeny ‘@) eH w. / b) Consumer No. a) iter} ante / c) Date of Registration 8) 2efivia +. /'d) Telephone No. 3) weiulea wi. a arte / 8) Work Order No. & Date (ar.5. deel areata & suai & fey) /b,c., & € for office use only) 2) sities & eee / Signature of Applicant ges wea WA / to be signed at the time of application With Rubber Stamp (wreath af or ar) a wee anfter/ANRAT MR HAP Hah sheet / a ara {fe tales 3 oofterem cen a (aa we areata et & fry get om / ooh ah site FARR mag Aerator e | 4 fret as after wee & fie ae Saha ooh oo faye | |, Shri/Smt/Ku. an Employee/Partner! Directon of the (Name of time/Gompany ete.) am duty by the firm/company to have the telephone registered & installed at address on. pbliaf'ok the Company / Fim etc. \Latfitm that the telephone js for bonafied use of the Company/tirm wana / Signature‘ie % feig_/ For Individual Customer ‘sxoutit He (anew Bar ig AF REre )/ SPEOMEN sicnxTUNE (ror CUSTOMER SEAVICES CENTRE) 3) pA GI aH / a) Name of the Company 28) m1B2 28. /'b) Consumer No. ‘7 woffa @) ara / c) Date of Registration 1a) 2aftwirt / d) Telephone No. 3} wnat a. @ arta / Work Order No. & Date : (amag eet crate soa % fey) /b,c,4,8 e for office use only) 3) sree wenn / Signature of Applicant ade axa wr / to be signed at the time of application With Rubber Stamp ee rigs eee pM (Uoereer eer are at FR TY ‘SPECIMEN SIGNATURES (to be given to customer at tha time of registration coher serita axa uy et CreleANA alent wt ane ar sy | To be given back to MTNL Staff at the time of Installation of phone ®) ett @ ArT / a) Name of the Company @ Wee w. / b) Consumer No. a iolien Hatter / c) Date of Registration a) exert 3. / d) Telephone No. 3) ratte a. 4 angie / 2) Work Order No. & Date (aug dae Grates & suatT % Ferg) / b,c.d, & for office use only) 3) artew % EMT / Signature of Applicant antea med WRI / to be signed at the time of application With Rubber Stamp A ae / pare am Ww caer ater & fay ander fone | °f, Prem aftart wear / are € fe we eaten WY axa oat} Rie e 1 1, ShriSmi/ku. Telephone connection to have installed at address ~ | atfirh that the telephone is for my bonafide use. Fr ( sheen @5 ra sree & Beater )