ISP-I

MAHANAGAR TELEPHONE NIGAM LIMITED,DELHI
APPLICATION FORM FOR NEW INTERNET CONNECTION
FOR HELPDESK USE
Opening Date-----------
Signature---------------
FOR OFFICE USE ONLY
Password Reference No.-------------
Customer Code--------------
Booking Date-------------- Signature--------






Note:Please read the instructions & broad terms and conditions before filling up the form.
1.PERSONAL/COMPANY DETAILS

A) Name
                                               


B)Address for
                                               


Correspondence
                                               


Pin
           

C) Contact Phone No.------------------              Fax No.-----------------------
(For informing account details)

2.SERVICE OPTED :(Please tick your choice)

PSTN Dial up PSTN Unlimited plan ISDN 64 Kbps ISDN 128 Kbps
100Hrs Lifetime   One Month   100 Hrs.Lifetime   100 Hrs. Lifetime  
250 Hrs Lifetime   Three Months   250 Hrs. Lifetime   250 Hrs. Lifetime  
500 Hrs Lifetime   Six Months   500 Hrs. Lifetime   500 Hrs. Lifetime  
    Twelve Months   1000 Hrs. 6Months   1000 Hrs. 6Months  

3.User/Login ID

Choice1
               
       Choice2
               


4.A) Additional Mail Storage:           -------------------MB(In Multiples of 2MB)
B) Additional Personal Web Space:  -------------------------MB(In Multiples of 2MB)
C)Additional E-Mail ID:                    Option1-------------------------- Option 2--------------------------
D)Fixed IP Access:                             PSTN-----------------------------ISDN--------------------------

6.PAYMENT PARTICULARS :
CASH/DD Number--------------------Date--------------Amount------------
Bank Name------------------------------Branch----------------------------
I/We have carefully read the terms and conditions of the agreement and technical specifications of MTNL Internet access Services and agree to abide by the same.

Date---------                                                                                   Signature of the Applicant






RECEIPT


Recieved from Mr./Ms-------------------------------------------------------------------------
Rs.------ -(In words,Rs.---------------------------------------------------------------------)
Vide Cash/DD No.-------------------------------------- Dated------------------------------
Drawn on ---------------------------------------------------------(Bank's Name & Branch)




Customer Code-----------------------                                                                 Signature


Note:1. Please quote your Customer Code No. for all future communications.
          2.Please ensure you get following things alongwith this acknowledgement:

                            1)Pasword Envelope
                            ii)Configuration Manual.

| Annexure | General Instruction |