APPLICATION
FOR ISDN REGISTRATION
Price Rs. 10/- For
ISDN Registration
Fee Rs. 3000/-
MAHANAGAR
TELEPHONE NIGAM LIMITED NEW DELHI
(Under Rule 414 of
the Indian Telegraph Rules 1951) Date of Issue ----------
(Valid for twelve
Calender months from the date of Issue)
Sl. No. 735765
Valid upto -------------
To,
The Chief General
Manager (Commercial Section).
Mahanagar Telephone
Nigam Limited
Delhi Telephones,
Khurshid Lal Bhawan, New Delhi-110050
For Office Use Only
Application No. C
0965500
Date of issue
-------------------------
C.A. No.
-------------------------
Telephone Exchange
-------------------------
Note Please read
instructions before filling application from
Name of applicant
Title (Dr., Er.,
Adv. etc.)
Surname First name
Second Name
Please leave one
column blank between Surname, First Name and Second Name
Category (Tick in
the appropriate box)
1. N.OYT-G 3.
N.OYT-SS 5. OYT-G 7. Tatkal
2. N.OYT-S 4.
N.OYT-SWS 6. OYT-S 8.
4. Dialling facility
required
1. Local Only 2.
Local & NSD 3. Local & NSD & ISD
5. 1. Residential
2. Business 3. Government
6. Status of
applicant --------------
See Instructions
7. Concessional
Group ----------------
See Instructions
& Attach supporting documents
8. Whether
applicant shall provide wiring within his/her premises ? Yes/No
9. Whether
applicant shall use his/her own Telephone instrument? Yes/No
10. Payment
particulars Amount Rs.----- Mode of payment (Pay Order/DD/cheque)
Pay Order/DD/Cheque
No. Dated------- Date----- Month----- Year-----
Bank & Branch
-------------------------------------------------------
11. Telephone
Installation address
House/Flat No.
Floor No. Building/Apartment Plot No.
Street/Road/Lane
Locality/Village/District
City PIN
12. Address for
correspondence
House/Flat No.
Floor No. Building/Apartment Plot No.
Street/Road/Lane
Locality/Village/District
City PIN
13. Existing
telephone numbers (if any) Fax Number (if any)
Nearest Telephone
No.
14. Is there any
telephone working in the name of the applicant anywhere /If Yes
Telephone
Number----------------------
Address
---------------------------------------------------
15. Billing Address
House/Flat No.
Floor No. Building/Apartment Plot No.
Street/Road/Lane
Locality/Village/District
City PIN
16. If the
application is for an EPABX Junction, indicate if MAIN or SUBSEQUENT
------------------------------
If SUBSEQUENT,
indicate MAIN telephone number ------------------
17. If the
applicant is a Partnership Firm or Hindu Undivided Family (HUF),
please furnish the
following
Name of the karta
of HUF -------------------------------------------------
Name in full of
members of HUG/Partnership Father's Name Relation to Karta
Firm
----------------------------------
--------------------- ----------------
----------------------------------
--------------------- ----------------
----------------------------------
--------------------- ----------------
18. Nominee
Name
-----------------------------------------------------
Address
--------------------------------------------------
Relation to
applicant ------------------------------------
19. I/We hereby declare that in respect of the service provided against the application, I/We will abide by the Indian Telegraph Rules as amended from time to time.
Date
Place
Signature of the
applicant(s)
DUPLICATE APPLICATION FORM
(TO BE COMPLETED AND RETURNED ALONGWITH
PRESCRIBED APPLICATION)
MAHANAGAR TELEPHONE NIGAM LIMITED, DELHI
Application for
Telephone Valid for one year from the date of issue
Connection
(Under Rule 414 of
Indian Telegraph Rules 1951)
For Office Use Only
Application No. C
0965500
Date of issue
-------------------------
C.A. No.
-------------------------
Telephone Exchange
-------------------------
Note Please read
instructions before filling application from
Name of applicant
Title (Dr., Er.,
Adv. etc.)
Surname First name
Second Name
Please leave one
column blank between Surname, First Name and Second Name
Category (Tick in
the appropriate box)
1. N.OYT-G 3.
N.OYT-SS 5. OYT-G 7. Tatkal
2. N.OYT-S 4.
N.OYT-SWS 6. OYT-S 8.
4. Dialling
facility required
1. Local Only 2.
Local & NSD 3. Local & NSD & ISD
5. 1. Residential
2. Business 3. Government
6. Status of applicant
-------------- 7. Concessional Group ----------------
See Instructions
See Instructions & Attach supporting documents
8. Whether
applicant shall provide wiring within his/her premises ? Yes/No
9. Whether
applicant shall use his/her own Telephone instrument? Yes/No
10. Payment
particulars Amount Rs.----- Mode of payment (Pay Order/DD/cheque)
Pay Order/DD/Cheque
No. Dated------- Date----- Month----- Year-----
Bank & Branch
-------------------------------------------------------
11. Telephone
Installation address
House/Flat No.
Floor No. Building/Apartment Plot No.
Street/Road/Lane
Locality/Village/District
City PIN
12. Address for
correspondence
House/Flat No.
Floor No. Building/Apartment Plot No.
Street/Road/Lane
Locality/Village/District
City PIN
13. Existing
telephone numbers (if any) Fax Number (if any)
Nearest Telephone
No.
14. Is there any
telephone working in the name of the applicant anywhere /If Yes
Telephone
Number----------------------
Address
---------------------------------------------------
15. Billing Address
House/Flat No.
Floor No. Building/Apartment Plot No.
Street/Road/Lane
Locality/Village/District
City PIN
16. If the
application is for an EPABX Junction, indicate if MAIN or SUBSEQUENT
------------------------------
If SUBSEQUENT,
indicate MAIN telephone number ------------------
17. If the
applicant is a Partnership Firm or Hindu Undivided Family (HUF),
please furnish the
following
Name of the karta
of HUF -------------------------------------------------
Name in full of
members of HUG/Partnership Father's Name Relation to Karta
Firm
----------------------------------
--------------------- ----------------
----------------------------------
--------------------- ----------------
----------------------------------
--------------------- ----------------
18. Nominee
Name
-----------------------------------------------------
Address
--------------------------------------------------
Relation to
applicant ------------------------------------
19. I/We hereby declare that in respect of the service provided against the application, I/We will abide by the Indian Telegraph Rules as amended from time to time.
Date
Place
Signature of the
applicant(s)
MAHANAGAR TELEPHONE NIGAM LIMITED DELHI
C 0965500 Specimen Signature of each person
SPECIMEN SIGNATURES SHEET
Application Form
No. ------------------------------- SPECIMEN SIGNATURES-I
Regn.
No.-----------------------Dated --------------
Name of the
Applicant (In Block Capital Letters)
----------------------------------------------------
Application Form
No. ------------------------------- SPECIMEN SIGNATURES-II
Regn.
No.-----------------------Dated --------------
Name of the
Applicant (In Block Capital Letters)
----------------------------------------------------
Application Form
No. ------------------------------- SPECIMEN SIGNATURES-III
Regn.
No.-----------------------Dated --------------
Name of the
Applicant (In Block Capital Letters)
----------------------------------------------------
INSTRUCTIONS TO BE FOLLOWED FOR FILLING
APPLICATION FORM
1. Please fill the boxes in block letters only.
2. The price paid for the application form is not subject to refund or adjustment and form is valid for a period of one year from the date of issue.
3. The application will be registered on payment of individual registration fee. Common bank draft for more than one application will not be accepted.
4. Individual must sign if the application is in individual individual's name.
5. In case of proprietory concern, proprietor must sign himself and affix rubber stamp.
6. In case of partnership concern, all partners or any one of the partners duly authorised or manager with the power of attorney may sign. In case of company, signatures should be of a person on behalf of the company, in accordance with the provisions of its Articles of Association.
7. In case of Govt. department, authorised person may sign and affix rubber stamp.
8. Copy of Documents duly attested may be attached as applicable :-
(a) Power of attorney in case of authorisation
(b) Registered partnership deed or partnership deed with from A issued by Registrar of Firms.
(c) In case of SSI Unit, permanent SSI certificate and personal liability certificate from the proprietor of the Unit.
(d) In case of Limited Co., a copy of the Articles of Association.
(e) In case of special category/concessional group. the relevent documents
9. Status of Applicant (please indicate one of the following) (fill in block letters only)
I. Individual VII.
PSU
II. Partnership
VIII. Govt.
III. Proprietorship
IX. Statutory body
IV. Ltd. Co. X. HUF
V. Public Inst. XI.
NRI
VI.
Society/Association/Trust XII. Foreign National
10. Concessional groups (Please indicate one of the following as applicable):
I. Freedom Fighter
IV. Disabled soldier
II. Gallantory
award winner V. Blind person
III. War Widow
11. Payment of registration fee is to be made by Cheque/Pay/Order/Demand Draft only, drawn in favour of "Mahanagar Telephone Nigam Limited, Delhi".
12. Contact
Telephone No. (If any) :
Fax No. (if any)
13. Please specify
the facilities required in case of ISDN line (Tick mark).
CLIR CF AGC CUG NSN
CH CLIP
(a) No. of
Terminals proposed to be
used : (Maximum of
Eight ISDN
terminals can be
connected to
NT 1)
(b) Type of
Terminals proposed to
be connected :
(i) Simple ISDN
Hand Set Yes No
(ii) ISDN Feature
Phone Yes No
(iii) ISDN PC Card
Yes No
(iv) Terminal
Adaptar Yes No
(v) G4 Fax Terminal
Yes No
(vi) Video
Telephone Yes No
(vii) Video
Conferencing Yes No
Equipment (This
requires 3 ISDN
Telephone Lines)
No. 735765 ANNEXURE - V
MAHANAGAR TELEPHONE NIGAM LIMITED NEW
DELHI
Four Specimen Signature of each person
SPECIMEN SIGNATURES SHEET
Application Form
No.------------------------------------ SPECIMEN SIGNATURES-1
Regn.
No.--------------------- Dated -------------------
Name of the
Applicant-----------------------------------
(in Block Capital
Letters)
Application Form
No. ----------------------------------- SPECIMEN SIGNATURES-2
Regn.
No.-------------------- Dated --------------------
Name of the
Applicant-----------------------------------
(In Block Capital
Letters)
Application Form
No.------------------------------------ SPECIMEN SIGNATURES-3
Regd.
No.-------------------- Dated --------------------
Name of the
Applicant-----------------------------------
(In Block Capital
Letters)
Application Form
No.------------------------------------ SPECIMEN SIGNATURES-4
Regd.
No.-------------------- Dated --------------------
Name of the Applicant-----------------------------------
(In Block Capital
Letters)
P.T.O