/fi6«sf] ;~rf/

g]kfn 6]lnsd
-g]kfn b"/;~rf/ sDkgL lnld6]8_

k|of]ustf{sf]
kf;kf]6{ ;fO{hsf] kmf]6f]
Nepal Telecom
gd:t] Wi-Fi ;]jf btf{ kmf/d
-s[kof kmf]6f]df l:6r gug{'xf]nf_
6 Months 12 Months Yes No
!= Kofs]hsf] k|sf/ Unlimited Basic Voice
Unlimited Premium Voice

@= u|fxssf] gfd y/
Customer’s Name
(in BLOCK Letter)
#= u|fxssf] 7]ufgf (Customer’s Address)
:yfoL b]z (Country) k|b]z (State) lhNnf (District)
(Permanent) uf=kf=÷g=kf= j8f g+= 6f]n ÷3/ g+=
xfn a;f]jf; ul//x]sf] b]z (Country) k|b]z (State) lhNnf (District)
(Temporary) uf=kf=÷g=kf= j8f g+= 6f]n ÷3/ g+=
$= u|fxssf] gful/stf g+= ;jf/L rfns kl/ro kq g+=
(Customer’s Citizenship No.) (Driving License No)
lat/0f ePsf] lhNnf (Issued District) hGd ldlt (Date of Birth) ........./............./.............
ljBfyL{sf] kl/rokq g+= (Student’s Identity No.) cleefjssf] gful/stf g+= (Parent’s Citizenship No.)
Passport No. (Foreigners Only) Nationality

%= u|fxssf] k]zf (Profession) ln· k'?if dlxnf cGo

(Gender) (Male) (Female) (Other)
^= u|fxssf] ;Dks{ df]jfO{n g+= O{d]n
(Contact No.) (email)
&= u|fxssf] afa'÷cfdf÷kltsf] gfd k|of]ustf{sf] cf}+7f 5fk
(Father’s / Mother’s / Husband’s Name)
*= u|fxssf] afh]sf] gfd
(Grand Father’s Name)
(= ;+3÷;+:yfsf] gfddf h8fg ePdf
(In case of Institution)
-s_ k|of]ustf{sf] gfd (User’s Name)
-v_ sfo{/t÷cWoog/t ;+:yfsf] gfd
(Name of Institution)
-u_ sfo{/t÷cWoog/t ;+:yfsf] 7]ufgf
(Address of Institution)
-3_ ;+3÷;+:yf k|d'v jf k|f]kfO{6/sf] gfd bfof“ afof“
(Name of Proprietor)
-ª_ Kofg gDa/ (PAN No.)
r_ ;Dks{ 6]lnkmf]g g+=
!)= Mobile Directory Number (MDN)

!!= dfly pNn]v u/] adf]lhdsf] l;d sf8{ a'lemlnP . o;df n]lvPsf] Joxf]/f 7Ls ;f“rf] xf], e"m7f 7x/]df sfg'g adf]lhd ;x'“nf a'emfp“nf .
!@= ;]jf k|of]u :yndf 4G sf] g]6js{ / u'0f:t/ ;DaGwdf d hfgsf/ 5' .

u|fxssf] b:tvt (Customer’s Signature) ldlt ........./........../.............

sfof{no k|of]hgsf] nfuL dfq

l;d jfktsf ]z'NsM =================================================================/l;b g+=M ======================================== Psfp06 g+========================================================
l;d sf8{ ljt/0f ldltM =========================== l;d sf8{sf] l;l/on gDa/M ================================================== df]afOn g+=M===========================================
b/vf:t ?h' ug]{sf] gfdM ======================================================================= kbM ======================= x:tfIf/========================== ldltM================================

CPE Serial No. : ======================================================================================================================================================================================================

g]kfn 6]lnsdsf] u|fxs btf{ kmf/d lgb{]zg adf]lhd /x]sf] k|dfl0ft ub{5' . x:tfIf/ 5fk
* u|fxs / ;]jf k|bfos larsf] ;Demf}tf k5f8L kfgfdf pNn]v ul/Psf] 5 .
;]jf k|bfos g]kfn b"/;+rf/ sDkgL lnld6]8 -g]kfn 6]lnsd_ / ;]jf k|of]ustf{ -u|fxs_ lar ul/Psf] ;Demf}tf
!= kl/efiffM
‘g]kfn 6]lnsd’ eGgfn] sDkgL P]g @)^# cg';f/ :yfkgf eO{ g]kfn b"/;+rf/ k|flws/0faf6 cg'dlt lnO{ g]kfn /fi6«df ;+rflnt g]kfn b"/;+rf/ sDkgL lnld6]8nfO{ hgfpg] 5 . o;n] g]kfn 6]lnsdsf] gfdaf6 ;]jf ;+rfng ug]{ 5
. o;nfO{ c|+u|]hLdf NEPAL DOORSANCHAR COMPANY LTD / ;+lIfKtdf ‘g]kfn 6]lnsd’ elgg] 5 . ‘u|fxs’ eGgfn] g]kfn 6]lnsdsf] ;]jf vl/b ;DalGw j}wflgs k|s[of k'/f u/L, ;]jf pkef]u ;DaGwL :jLsf/ u/L ;]jf pkef]u
jfktsf] cfly{s bfloTj jxg ug]{ m2m k|fs[lts tyf sfg'gL JolQmnfO{ hgfpg] 5. ‘;]jf’ eGgfn] g]kfn 6]lnsd cfk}mn] jf o;df ;]jf k'of{pg] lgsfox? dfk{mt u|fxsx?nfO{ pknAw u/fpg] df]afOn ;]jf ;lDemg' k5{ . ‘df]afOn
gDj/’ eGgfn] s'g} u|fxs nfO{ pknAw u/fPsf] df]afOn 6]lnkmf]g gDj/nfO{ a'emfpg] 5 . ‘df]afOn g]6js{’ eGgfn] df]afOn 6]lnkmf]g ;]jf ;+rfng ug{ k|of]u ul/g] l8lh6n b'/ ;+rf/ g]6js{, :6]zg, l:jlrª, dfOqmf]j]e, j]; :6]zg
;d]t, cGo b"/;+rf/ pks/0f ;Demg' kb{5 . ‘;'/If0f w/f}6L’ eGgfn] u|fxsnfO{ l;dsf8{ pknAw u/fp“bfsf avt g]kfn 6]lnsddf df]afOn ;]jf ;+rfngsf] nfuL w/f}6Lsf] ?kdf hDdf u/]sf] lglZrt /sdnfO{ ;Demg' kb{5 .
‘dxz'n’ eGgfn] g]kfn 6]lnsdn] u|fxsnfO{ ;]jf pknAw u/fP jfkt nufPsf] z'NsnfO{ hgfp“b5 / o;n] ltg{ af“sL ;]jf z'Nssf] e'QmfgL ;Demg' kb{5 . ‘sfa' aflx/sf] kl/l:ylt’ eGgfn] s'g} b}jL 36gf ;a} vfn] cfkt\sflng
kl/l:ylt, ;/sf/ jf cGo s'g} ;Ifd ;/sf/L lgsfon] s'g} sfd ubf{ jf gubf{ k/]sf] kl/0ffd, cfuhgL, r6\ofª, @$ 306f eGbf a9L nuftf/ ljB't cfk'lt{ aGb x'“bf, laikmf]6g, af9L, dfxfdf/L, 9'jfgL jf cfjt hfjtdf /f]s, o'4
;d]tnfO{ ;Demg' kb{5 .
@= ;Demf}tf nfu" x'g] / jxfn x'g] ldltM
g]kfn 6]lnsdn] lgj]bssf] lgj]bg :jLs[t u/L df]afOn gDj/ pknAw u/fPsf] ldlt b]lv of] ;Demf}tf nfu' ePsf] dflgg] 5 / of] ;Demf}tf :yfoL ?kdf ;]jf cGTo geP ;Dd nfu' eO{/xg] 5 . ;fdfGotM of] ;Demf}tfdf b'j} kIf
af6 x:tfIf/ ul/g] 5 t/ ;Demf}tfdf x:tfIf/ gu/]s} sf/0f af6 dfq of] ;Demf}tf lgis[o ePsf] dflgg] 5}g / sf/0faz s'g} JolQmn] ;Demf}tf gu/L g]kfn 6]lnsdsf] df]afOn ;]jf k|of]u u/L ;s]sf] eP klg of] ;Demf}tfsf zt{x?
b'j} kIfn] kfngf ug{'kg]{5 / To:tf u|fxssf] xsdf of] ;Demf}tf eP ;/x dflgg] 5 .
#= -s_ sDkgLsf] bfloTjM
g]kfn 6]lnsdn] u|fxsnfO{ o; ;Demf}tfsf zt{ d'tfljs ;]jf k|bfg ug]{5 . sDkgLn] b"/;+rf/ k|flws/0faf6 :jLs[t ePsf dxz'n b/ ;fj{hlgs ;"rgf dfk{mt hfgsf/L lbOg]5 . sDkgLn] u|fxsnfO{ clwstd dfl;s ;'ljwf
l;df sfod ug]{, pwf/f] Joj:yfkg ug]{ / u|fxsnfO{ ;]jf k|bfg ug]{ ;DaGwdf k]ZsL :j?k /sd lng] jf ;]jf lgnDjg ug]{ jf ;]jfx? cf+lzs jf k"0f{ ?kdf ljR5]b ug]{ yk ;]jf ;'ljwf pknAw u/fpg] ;DaGwdf u|fxs;“u 5'6\6}
;Demf}tf u/L nfu' ug{ ;Sg]5 . s'g} u|fxssf] ljj/0f P]g, sfg'g adf]lhd g]kfn ;/sf/ jf ;DalGwt lgsfon] dfu]sf] a]nf g]kfn 6]lnsdn] s'g} klg ;dodf To:tf lgsfo ;dIf k]z ug{ ;Sg]5 . To;/L sfg'g ;Ddt
pknAw u/fOPsf] ljifonfO{ u|fxssf] uf]klgotf e+u ePsf] elg ph'/L ug{ kfpg] 5}g .
#= -v_ u|fxssf] bfloTjM
u|fxsn] g]kfn 6]lnsdsf] ;]jf k|of]u ubf{ k|rlnt g]kfn sfg'gsf] k"0f{ kfngf ug'{ kg]{5 . u|fxsn] ;]jf pkof]u ug]{ ;DaGwdf g]kfn ;/sf/, g]kfn b"/;+rf/ k|flws/0f jf g]kfn 6]lnsdn] lbPsf lgb]{zgx? kfngf ug'{ kg]{5.
u|fxsnfO{ pknAw u/fOPsf] ;]jf afkt /sd u|fxsn] ltg'{ kg]{5 . /sd ltg]{ a]nfdf g]6js{ jf ;]jf pkof]u gu/]sf] bfjL ug{ kfpg] 5}g . lan :6]6d]G6sf] ;DaGwdf ljjfb ePdf To:tf] ljjfbsf] 6'ª\uf] gnfu] ;Dd lan
:6]6d]G6df pNn]lvt /sd u|fxsn] w/f}6Lsf] ?kdf hDdf ug'{ kg]{ 5 . u|fxsn] g]kfn 6]lnsdsf] g]6js{df cg'kfng ( Compliance ) x'g] ;fwgx? dfq k|of]u ug'{ kg]{ 5 . u|fxsn] ;]jf u|x0f ul/ ;s] kl5 u|fxss} sf/0f ;]jf
;+rfng gu/] klg ;f] cjlw ;Dd Go"gtd dfl;s dxz'n e'QmfgL ug'{ kg]{5 . g]kfn 6]lnsdsf] k"j{ :jLs[lt ljgf o; ;Demf}tf cGtu{t u|fxsnfO{ k|fKt x'g] clwsf/ jf kmfObf jf bfloTj u|fxsn] c? s;}nfO{ x:tfGt/0f ug{ kfpg]
5}g . s'g} klg cj}wflgs p2]Zosf] nfuL ;]jf k|of]u ug]{ jf s;}nfO{ lk8f lbg, b'Mv lbg, lbSs u/fpg jf xtf]T;flx agfpg g]kfn 6]lnsdsf] ;]jf k|of]u ug{ kfpg] 5}g . u|fxsn] ;]jfsf] pkof]u ubf{ s'g} klg k|sf/sf] cg'lrt,
cg}lts jf u}/sfg'gL k|of]hgsf] nfuL jf ;]jf g]6js{ ;+rfngsf] p2]Zodf g} k|lts'n k|efj ug{ kfpg] 5}g / c? s;}nfO{ ;d]t k|of]u ug{ lbg] 5}g . o;f] u/]df sfg'g ljk/Lt x'g] 5 . u|fxsn] ltg{ af“sL /x]sf] /sd ;/sf/L
aSof}tf ;/x k|rlnt sfg'g cg';f/ c;'n pk/ ug{ ;Sg] 5 / u|fxsn] klg ltg{ afWo x'g] 5 .
$= g]kfn 6]lnsdn] jxg gug]{ bfloTjM
u|fxsn] ;]jf pkof]u ug]{ qmddf ePsf] Jofkf/sf] gfkmf, /fh:j, VoftL, cg'dflgt art, s/f/ h:tf h'g s'g} lsl;daf6 x'g ;Sg] k|ToIf jf ck|ToIf xfgL gf]S;fgLsf] nfuL g]kfn 6]lnsd hjfkmb]xL x'g] 5}g . To;} u/L, 8f6f
l;Ugn cfbfg k|bfg ug{ ;]jf k|of]u ubf{ g]kfn 6]lnsdsf] sfa' aflx/sf] kl/l:yltdf k/L 8f6fdf s'g} Iflt jf cz'4 ePdf tyf ;]jf k|of]u ubf{ x'g] k|ltlnkL clwsf/ ;DalGw bfla jf ;]jf ;Gbe{df u|fxsn] s'g} sfd ubf{ jf gubf{
s'g} k|sf/sf] bfjL pTkGg ePdf sDkgL hjfkmb]xL x'g] 5}g . g]kfn ;/sf/ jf cGo ;DalGwt clwsf/L af6 hf/L ul/Psf] s'g} cfb]z jf sfo{ af6 pTkGg s'g} gf]S;fgL jf c;'ljwf ePdf g]kfn 6]lnsd hjfkmb]xL x'g afWo x'g] 5}g .
g]kfn 6]lnsddf sfnf] ;'lrdf /x]sf] JolQm ;]jf ;DalGw cfly{s bfloTj k'/f gu/]sf] JolQm, 6f6 kN6]sf] jf cbfntaf6 bfdf;fxLdf sf/jfxL ePsf] JolQm, cfj]bg kmd{df pNn]lvt tYo n'sfpg] cfzon] unt ;'rgf lbg] JolQm,
g]kfn ;/sf/ jf ;DalGwt lgsfoaf6 ;]jf glbg' egL lgb]{zg eO{ ;'lrdf k/]sf JolQmx?sf] ;DaGwdf sDkgL lt JolQm ;“u ;Demf}tf ug{ afWo x'g] 5}g .
%= df]afOn -l;dsf8{_ gDj/ kl/jt{g tyf ;]jf ;'ljwfM
df]afOn gDj/ kl/jt{gsf] nfuL u|fxsn] g]kfn 6]lnsdn] tf]s]sf] b:t'/ ;lxt cfk\mg} x:tfIf/ ;lxtsf] lgj]bg lbP kl5 gDj/ kl/jt{g ug{ ;lsg] 5 . t/ g]kfn 6]lnsdn] u|fxssf] ltg{ af“sL /sd eP ;f] /sd e'QmfgL geP
;Dd gDj/ kl/jt{gsf nflu lbPsf] lgj]bg pk/ s'g} sf/jfxL x'g] 5}g .
^= gd:t] jfO{kmfO{ ;]jfsf] Kofs]h ;DaGwL hfgsf/Lsf] nfluM
offer.ntc.net.np df log in ug"{xf];\ .
&= lalqm ÷ x:tfGt/0f
g]kfn 6]lnsdsf] ;xdlt ljgf h8fg ul/Psf] ;]jfsf] :jfldTj xs x:tfGt/0f ug{ kfOg] 5}g . cfkm} lglh tj/n] xs x:tfGt/0f u/]s} sf/0f af6 u|fxssf] af“sL /x]sf] bfloTj ;dfKt x'g] 5}g . u|fxs afx]ssf JolQmaf6 lan
e'QmfgL ePs} sf/0fn] dfq u|fxssf clwsf/ tyf bfloTj x:tfGt/0f ePsf] dflgg] 5}g . xs x:tfGt/0f tyf gfd;f/L ug{ u|fxsn] sDkgLnfO{ ltg'{ kg]{ ;Dk"0f{ /sd clgjfo{ e'QmfgL ug'{ kb{5 . ;f] eP kl5 dfq k|s[of cuf8L
a9fOg] 5 .
*= ;]jf ÷ dd{t ;DalGw ph'/L
;]jf ;DalGw s'g} u'gf;f] ePdf 6]lnsdn] pknAw u/fOPsf] ;Dks{ g+= df u|fxsn] lnlvt jf df}lvs ?kdf g]kfn 6]lnsdnfO{ hfgsf/L u/fpg' kg]{5 . g]kfn 6]lnsdsf] l;dsf8{ x/fPdf, rf]l/Pdf, lalu|Pdf jf cGo s'g} tl/sfn]
cglws[t k|of]u ePdf tTsfn u|fxsn] sDkgLnfO{ hfgsf/L u/fpg' kg]{5 . x'/L atf;, rSsfhfd, ef}uf]lns ljs6tf k|fs[lts ljkt h:tf ljz]if kl/l:ylt afx]s cGo ;dodf g]kfn 6]lnsdn] d'Vo df]afO{n l:jr jf j]z :6]zg
sG6«f]n / l;:6d lju|g uO{ ;Dk"0f{ u|fxssf] df]afOn ;]jf cj?2 ePdf cfk\mgf] ;]jf oyfl;3| dd{t u/L ;]jf ;+rfng ul/g]5 . s'g} b}jL 36gf, ;a} vfn] cfktsflng kl/l:ylt, ;/sf/ jf cGo s'g} ;Ifd ;/sf/L lgsfon] s'g}
sfd ubf{ jf gubf{ k/]sf] kl/0ffd, cfuhgL, r6\ofª, rf}la; -@$_ 306f eGbf a9L nuftf/ laB't cfk'lt{ aGb x'“bf, laikmf]6, af9L, dxfdf/L, o'4, sfa' aflx/sf] kl/l:yltsf] sf/0fn] ;]jf ca?4 x'g uPdf ;Demf}tf cg';f/ cfk\mgf] bfloTj
/ st{Jo k'/f ug{ c;dy{ ePdf ;Demf}tf pNnª\3g ePsf] dflgg] 5}g . sfa' aflx/sf] kl/l:yltsf] sf/0fn] ;]jf ca?4 x'g uPdf ;Demf}tf cg';f/ cfk\mgf] bfloTj / st{Jo k'/f ug{ c;dy{ ePdf ;Demf}tf pNnª\3g ePsf] dflgg]
5}g . sfj' aflx/sf] kl/l:yltsf sf/0fn] u|fxsn] kfpg' kg]{ ;'ljwfdf k|lts'n k|efa k/]df jf ca?4 ePdf u|fxsn] ltg'{ kg]{ Go'gtd dfl;s z'Ns k|ltlbgsf] bfdf;flxsf] b/n] ldgfxf ul/g] 5 . u|fxsnfO{ k/]sf] cGo Ifltk'lt{ ltg{
g]kfn 6]lnsd afWo x'g] 5}g .
(= ljjfb tyf ;dfwfg
u|fxsn] ;]jf tyf dxz'n ;DaGwdf s'g} lnlvt lzsfot÷ph'/L lbPdf tf]lsPsf] ;ldltn] 5fgljg ul/ ;f] ;ldltsf] lg0f{o adf]lhd x'g]5 . pQm lg0f{o pk/ lrQ ga'e]mdf u|fxsn] b'/;+rf/ P]g, lgod adf]lhd k|flws/0f ;dIf ph'/L
ug{ ;Sg] 5 . k|flws/0fn] u/]sf] lg0f{o u|fxs tyf g]kfn 6]lnsd b'j} kIfnfO{ :jLsfo{ x'g]5 . ;Demf}tfdf s'g} ljjfb pTkGg ePdf ;f] ljjfb k|rlnt g]kfn sfg'g adf]lhd ;dfwfg ul/g]5 .
!)= If]qflwsf/ tyf dfGotfM
;Demf}tfsf] zt{x? g]kfn sfg'g ;“u af“lemPdf af“lemPsf] xb ;Dd :jtM lgis[o x'g] 5 . of] ;Demf}tfsf] s'g} bkmf ;+zf]wg jf cdfGo ePdf jf x'g uPdf To;sf] cGo bkmfsf] dfGotfdf s'g} c;/ kfg]{ 5}g .
!!= ;Demf}tfsf] ;dflKtM
u|fxsn] h'g;'s} a]nf ;'rgf lbO{ ;Demf}tf cGTo ug{ ;Sg]5 . o;/L ;'rgf lbPsf] & lbg leq u|fxsn] ltg{ a'emfpg jf lkmtf{ kfpg] /sd bfjL ug'{ kg]{5 . ;f] cjlw leq lghn] k|of]u u/]sf] ;]jfsf ;j} ljj/0f ;DaGwL b:t'/ / lghn]
k|fKt u/]sf] ;]jfsf] dxz'n glt/];Dd ;'rgf lbOPs} sf/0fn] ;Demf}tf cjlw ;dfKt x'g] 5}g . ltg{ a'emfpg af“sL /x]sf] dxz'n /sd sfg'g adf]lhd c;'n pk/ ug]{5 . u|fxssf] tk{maf6 ;Demf}tf ;dfKt ug{ eGbf cuf8L lghn]
ltg{ af“sL /sdx? ltg{ lghsf] bfloTj x'g]5 . u|fxsn] ;Demf}tfsf s'g} zt{x? pNnª\3g u/]df g]kfn 6]lnsdn] sf/0f vf]nL ;'rgf lbO{ s'g} klg ;dodf ;Demf}tfsf] cjlw ;dfKt ug{ ;Sg]5 . t/ ljz]if kl/l:ytLdf
;Demf}tfsf] cjlw ;dfKt ug'{ k/]df ;DalGwt lgsfo ;dIf afx]s u|fxsnfO{ sf/0f ;lxt hfgsf/L lbg afWo x'g]5}g . g]kfn 6]lnsdsf] sd{rf/L jf cflwsf/Ls k|ltlglw, ljt/s, l8n/, clestf{nfO{ s'g} u|fxsn] k|ToIf jf
ck|ToIf ?kn] s'g} pkxf/ k|:tfj u/]sf] s'/f g]kfn 6]lnsdnfO{ hfgsf/L k|fKt ePdf k|rlnt sfg'g cg';f/ sf/jfxL ul/g]5 .
!@= ;"rgf lbg] M
zt{ cg';f/ lbg'kg]{ s'g} ;"rgf g]kfn 6]lnsdsf] sfof{nodf jf /lhli6« btf{ ul/ ;"rgf lbg ;lsG5 .

lj:t[t hfgsf/Lsf] nfluM www.ntc.net.np df log in ug"{xf];\ .

yk hfgsf/Lsf] nflu !$(* df sn ug'{xf];\ ,
:jM3f]if0ffM o; ;Demf}tfsf zt{x? xfdLx?n] /fd|/L k9]sf / a'e]msf 5f} . xfdL zt{x?sf] k'0f{ ?kdf kfngf ub{5f}+ elg o;} dfk{mt sa'n ub{5f}+ . o; ;Demf}tfsf zt{x? ;do ;dodf kl/jt{g x'g ;Sb5 eGg] s'/fdf
xfdL ;xdt 5f} .
u|fxssf] tk{maf6M
x:tfIf/M
gfdM
;+:yfut u|fxssf] gfd, 7]ufgf, 5fkM

ldltM