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)

Type Of Plan Duration Life Time  Pstn Tarif ISDN 64k ISDN 128k Email Mail Memory Free Web Space
Plan I 100hrs 500 1000 2000 4 8MB 2MB
Plan II 2500hrs 1000 2000 4000 10 6 12MB
Plan III 500hrs 1500 3000 6000 6 20MB 2MB
ISDN Flat 1000hrs @ 5/- Per Hrs____@ 10/- Per Hrs 4 8M 4MB
Validity Period Rate
One Month 200
Three Month 500
Six Month 1100
Twelve Month 2000

 

3.User/Login ID

Choice1
               
       Choice2
               


4. Additional E-mail Id

Option 1 Option 2
 1    
 2    
3    
4    

5.  Additional Mail Storage ( if Required )__________________MB (In Multiple Of 1 Mb)

6. Additional E-mail Id : (on Extra Payment Basis) .....................................(Option1).....................(Option2)

7. 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 |