Application No.____________________________Dated____________________________________________________

1. Name of the Applicant_________________________________________________________________________

2. Postal Address : ______________________________________________________________________________

3. Nature of Business : ___________________________________________________________________________

4. Central Government___________________________________________________________________________

State Government.

Private Firm.

Private/Individual

5. Address at which the Fax Machine_______________________________________________________________

is proposed to be located.

6. Purpose *(See note Below) for Own/ for Public use.

7. How the Fax Machine is propose_________________________________________________________________

to be connected.

(a) On Telephone No.________________________

for use over PSTN ________________________

(b) On leased line between____________________Station_________________________

and____________________Station________________________

8. Name & Type of the machine____________________________________________________________________

Propose to be used_____________________________________________________________________________

9. Manufacture's Name : _________________________________________________________________________

Signature of the applicant

Place : ______________ Name/Designation.

Date : ______________ Organisation

1. Annual licence fee for own use Rs. 3000/-

2. Annual licence fee for public use Rs.15000/-

licence who/take permission for own use will not be allowed

to receive/transmit documents/charts from the general public

We____________________________________________________________________________

hereby agree to the following terms conditions in the event of our request for licence is granted.

1. We are aware that licence is governed by the Indian Telegraph Act & Rules framed there under and that we will abide by them.

2. We shall pay regularly to the Department to Telecom during the continuance of the licence such sums fixed by the Department as licence fee and in such a manner as prescribed by the Department of Telecom.

3. We shall also pay such other charges( Call charges rentals etc.) as are/may be prescribed by the Dept. of Telecom during the continuance of the licence.

4. We indemnity the Department of Telecom, for any loss caused due to errors in transmission through FAX Machines. Nor will the Department of Telecom,liable to pay any damages caused to the improper functioning of the FAX machine.

5. We are aware that the inability to establish or use FAX communication link licenced by the Dept. of Telecom is no ground claiming refund of licence fee.

6. We will use only the mark/type of the machines for which the licence is granted and will not substitute any other make/type without the consent of the Dept. of Telecom.

7. We will remove the retrial facility if available in the make/type of the machine for which licence is applied. (Note Fax machines with successive retrials will not be permitted.)

8. We will use the FAX transmission facility only for sending/receiving documents/

charts/drawings connected with our own business and that facility for transmission reception of documents/charts/drawings of the general public of other organisation.

OR

We will use FAX facility only for providing FAX service for public use subject to the provisions of the Indian Telegraph Act & rules.

9. We are aware that the maintenance of the FAX machine( Subscriber's owned) is fully our resposibility and the Dept. of Telecom is not liable to repair the machine.

10. We are aware that in the event of violation of any of the above conditions or violation of Indian Telegraph Act/Indian Telegraph rules,Dept. of Telecom will revoke the licence.

* Strike out which ever is not applicable