MAHANAGAR TELEPHONE NIGAM LIMITED, DELHI
Application for IN Services
For Office Use Only
Free of CostApplication No. IN
Date of issue ________________________
C.A. NO. ________________________
Telephone Exchange ________________________
Note: Please read instructions before filling application form
1. Name of Applicant
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Surname First Name Second Name
Please leave one column blank between Surname, First Name and Second Name
2. Name of father/husband/guardian
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Surname First Name Second Name
Please leave one column blank between Surname, First Name and Second Name
3. Purpose of use
1. Residential ---- 2. Business ---- 3. Government ----
4. Status of applicant_________________________________
(See Instruction)
5. Payment particulars Amount Rs.________Mode of payment (Pay Order/DD)________
6. Pay Order/DD No.------------------------- Dated -------- -------- ------------
Date Month Year
Bank & Branch_____________________________________________________
7. Address for correspondence
--------------------------- ---------------- ---------------------------- ---------------
House/Flat no. Floor No. Building/Apartment Plot No.
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Street/Road/Lane Locality/Village/District
------------------ ------------------
City PIN
8. Contact Telephone Number (if any) ----------------------
Contact Fax Number (if any) ----------------------
Nearest Telephone No. ----------------------
9. Is there any telephone working in the name of the applicant anywhere in the country(Yes/No)
If Yes
Telephone Number --------------------------
Address _________________________________________________________
10. Billing address:
--------------------------- ---------------- ---------------------------- ---------------
House/Flat no. Floor No. Building/Apartment Plot No.
------------------------------------------------ ------------------------------------------------
Street/Road/Lane Locality/Village/District
------------------ ------------------
City PIN
11. If the applicant is a Parternership Firm or Hindu Undivided Family (HUF), please furnish the following
Name of the Karta of HUF_________________________________________
Name in full of members of HUF/Partnership Firm Father's Name Relation to Karta
_____________________________________ ___________ ___________
_____________________________________ ___________ ___________
_____________________________________ ___________ ___________
12. Nominee
Name _________________________________________________________
Address _________________________________________________________
Relation to applicant __________________________________________________
FACILITIES REQUIRED ON
FREE PHONE SERVICE (FPH)/PREMIUM RATE SERVICE (PRM)
(please read information on page 6 carefully before filling up the following entries)
13. EXISTING NUMBER & ADDRESS ON WHICH FPH/PRM Telephone No.
-----------------------
IS REQUIRED (In case on which FPH, charging will also be done on this number)
Address on which IN Service is required
--------------------------- ---------------- ---------------------------- ---------------
House/Flat no. Floor No. Building/Apartment Plot No.
------------------------------------------------ ------------------------------------------------
Street/Road/Lane Locality/Village/District
------------------ ------------------
City PIN
14. TIME DEPENDENT ROUTING INFORMATION (See item 19 on page 5)
Phone No Address Time Slot
(i) From --------hrs. TO --------hrs.
(ii) From --------hrs. TO --------hrs.
15. ORIGIN DEPENDENT ROUTING INFORMATION (See item 20 on page 5)
Phone No. Address
(i)
(ii)
(iii)
(iv)
16. CALL FORWARDING INFORMATION (See item 21 on page 5)
Phone No. Address When
(i) Busy
(ii) No Reply
OTHER DETAILS
17. ADDITIONAL DETAIL BILLS WHETHER REQUIRED (See item 17 on page 5)
YES -------- NO --------
18. PERIOD OF HIRE (See item 18 on page 5)
I/We agree to abide by the provision of Indian Telegraph Rules in force and as also such amendments as may be made from time to time to these rules, in so far as they relate to this IN connection now or at a later date.
I further confirm that all the telephone numbers are given in the form above for FPH/PRM service belong to me/us.Any dispute arising out to these numbers, responsibility shall rest on me/us.
Date: (Signature) ______________________
Place: (Name in Block letters) _______________
Stamp ______________________
SPECIMEN SIGNATURES SHEET
APPLICATION FORM NO. _________________________ SPECIMEN SIGNATURE-1
Regn. No. _________________ Date ________________
Name of the Applicant (In Block Capital Letters)
_______________________________________________ (Stamp)
APPLICATION FORM NO. _________________________ SPECIMEN SIGNATURE-1
Regn. No. _________________ Date ________________
Name of the Applicant (In Block Capital Letters)
_______________________________________________ (Stamp)
APPLICATION FORM NO. _________________________ SPECIMEN SIGNATURE-1
Regn. No. _________________ Date ________________
Name of the Applicant (In Block Capital Letters)
_______________________________________________ (Stamp)