Tariff plan and standard terms & conditions also  attached

                                                                          Trump Copy                                                
Mobile No.  Sim No. Date


Type of application    Individual         Company    Other (specify)___________________
NAME                             ______________________________________________________
Residential Address      ______________________________________________________          Affix your
                                      ____________________________________________________        passport size
                                      _____________________________________________________     recent photo
Local Address               ____________________________________________________
 (In case of                       ______________________________________________________                 
outstation subscriber)


Date of Birth  Contact No. Sex M F E-Mail __________ 
                     d   d  m  m  y   y

DECLARATION
I hereby declare that the above information is wholly true. I have read and understood the tariff plan and the terms & conditions .I hereby agree to abide by them .  I also agree that my cellular connection is subject to verification, evaluation and acceptance by MTNL.

Date ____________                                                                 Subscriber’s Signature_____________

 
CSC-I/C/Franchisee
Signature with stamp		  

PAN No.         GIR No.                    Form 60

PAN/ GIR No. _______________________

In case of PAN No. attach copy of PAN Card ,If not available, please fill up Form 60 given below

 


FORM 60

(See third provision to rule 114B)

Form of declaration to be filled by a person who does not have either a PAN or GIR no. and who makes payment in cash in respect of transaction specified in clauses (a) to (h) of rule 114B.

1. Full Name & address of the Declarant  ___________________________________________________

                                                            ___________________________________________________

2. Particulars of transaction                      __________________________________________________

3. Amount of the transaction             _____________________________________________________

4. Are you assessed to Tax?               Yes/ No

5. If yes,

(i) Details of Ward/ Circle/ Range were the last return of income was filled.

(ii) Reasons for not having Permanent Account Number- General Index
     Register Number.

6. Details of the document being produced in support of address mentioned above. ____________________

VERIFICATION

I __________________________________________ do hereby  declare that what is stated above is true to the best of my knowledge and belief.

Verified today, the ___________ day of _____________ (month) 20 ___________

Date ___________

Place __________

Signature of the declarant

INSTRUCTIONS

(a)Please furnish the proof of identity and address by one or more of the following documents as applicable:
    (i) Income Tax PAN card (ii) Passport (iii) Voter I.D. Card (Election Card) (iv) Driving Licence (v) 
          Armed Licence (vi) Any Photo Identity Card issued by any statutory /Government Authority.
          The same documents will hold good for form 60.

(b) Public Limited Cos. may enclose Certificate of incorporation, Memorandum of Articles, duly signed by
     M.D./ Director of the Company along with any proof of identify as above of the authorized officer of the
     Company. In case application is signed by authorized signatory, then attested photocopy or Power of
     Attorney must be attached.

(c) In case of Govt. of India Undertaking ,Govt. of India offices/ state Govt. Offices, the aforesaid
     requirements are dispensed with and self-certification on the letter head will suffice along with the
     name and designation of the coordinating officer to be consulted in case of need.

(d) In case of foreign Missions in India and other foreign agencies ,the name and designation of the
     authorized officer along with details of officials etc. for whom the Cellular  Mobile Phone is intended.
 
(e) In case of outstation subscribers, details of local reference (s) to be given.

(f) Payment will be accepted by cash/ demand draft/ pay order in favour of “MTNL Delhi Dolphin”.

(g) The charges of Trump Card and recharge coupons are indicated on the packing case/coupons and are non-refundable under any circumstances what so ever.

(h) The Trump card can be put to use only after activating it with appropriate Trump recharge coupon,
     which can be purchased separately (Denomination of your choice).

 

Regd. & Corporate Office : Managar Telephone Nigam Limited, Jeevan Bharati Bldg., Tower-I
                                               12th Floor, 124, Connaught Circus, New Delhi-110001.
                                                Website :www.mtnl.net.in     http://delhi.mtnl.net.in

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