To

Sir,

Please arrange for the shifting of my/our Telephone No...........................as per particulars given below :

1. NAME OF THE SUBSCRIBER...................................................................................................

(IN BLOCK CAPITAL LETTERS)

2. CORRESPONDENCE ADDRESS..............................................................................................

3. ADDRESS WHERE THE TELEPHONE

IS/WAS WORKING

4. State whether the telephone is working

at present or it has been disconnected

under shift/safe custody/due to non-payment

if so,give the full particulars & date

(A photo copy of latest bill paid-to be attached)

5. Accessories presently working on the Telephone

6. Are the accessories presently working

required at the New address also

7. (a) Address where the telephone is

required to be shifted.

(b) Status of applicant in the organisation

firm or company if the telephone is required

to be shifted to address of firm or company

care of address.

3. Number of the nearest working on the Telephone.

8. If the telephone shifting is not immediately

feasible whether the telephone connection should

continue to work at its present address or it should

be closed under shift.

9. BILLING ADDRESS OF SUBSCRIBER DURING

PERIOD OF DISCONNECTION UNDER SHIFT.

10. State if subscriber will carry the instrument with him

to the new place of installation.

11. Reason for shifting :

(SIGNATURE OF THE SUBSCRIBER)

1. Whether the telephone is working or disconnected.

2. Date of disconnection if disconnected.

3. Out-standing bills of the subscriber,if any.

        [ACCOUNTS OFFICER (TR)C-]

NOTE :  1. Signature of subscriber should be attested by Gazetted Officer/Manager of Nationalised bank.

               2. Photocopy of last paid bill. Should Attached After Paying The bill