BHARAT SANCHAR NIGAM LIMITED (Website : wor bsnl.coil PLIC RM NDER OF TELEP! 1, Name of the Subscriber 6-M-BALAMURUGAN 2. Telephone Number f =24AESUSBS eeonseanp) 3. Type of telephone p @ Basic/FWT Gi) WL Oct i (0 in Cet rot AND 4. Address where telephone is installed Ni TMENT, . EsBLC, PAVENDAR Saal, WH A, 5 Date from which telephone is required PIARAIMALAINAGAR — G0 3209. tobe clos - 6. Reasons for surrender of telephone [Please tick the appropriate reasons] Moving to some other city Being an additional phone, not required Death of the original allottee Financial Constraints Closure of business ‘Taking another type of connection from BSNL in place of this telephone Taking Mobile / fixed telephone from other rox poet company Not satisfied with BSNL's service on account of i) Billing problems ii) Commercial problems iil) Frequent faults iv) Improper behavior by BSNL staff (please give details) 9. Any other reasons (please specify): 7. Address on which refund of security Z AQ, deposit afer adjustment of outstanding Fe NAKSHATCA APARTMENT “Tn sits Seas Sal Sl §. Contact telephone No, if any 209yrersh undertake to pay any amount due to BSNL even after closure ofthe telephone connection. Signature of the C Name:_S_W.BALAMURUGAN) RECEIPT Received an application for closure w.e.£ connection No. working in he name of Shai A, telephone Dated of receint of anolication : i Time of R, ‘eceint: