BHARAT SANCHAR NIGAM LIMITED (website address) FORM FOR NEW TELEPHONE CONNECTION Affix self signed passport size photograph (required for ISD facility only) Companies/ Organizations Individuals (tick appropriate box) (Please read the instructions before filling the form) 1. A. Title/ Name of the Customer/ Company/ Firm/ Organization (SURNAME FIRST) B. Name of the Joint Applicant, if any 2. Name of Father/ Husband/ Group/ Proprietor/ Partner(s) 3. PAN/GIR No: (Please see Instruction # 2) 4. No. of telephone connections required: In words In figures (Please see Instruction # 3(a) 5. Telephone No. working, if any: 6. Complete Address where telephone(s) is/ are required: House No Street/ Road/ Village Bldg./Appt. Area/ Locality/ Tehsil City/ District Pin 7. Billing/ Correspondence Address (if different from 5 above) 8. E-mail address (if any): _______________________@______________________ 9.Category Code 10. Concessional Group Code (please write Code No. as indicated in instruction No.10) (please write Code No. as indicated in instruction No.11) 11. Purpose: Residence Business Govt. PSU 12. Facilities Required (tick whichever is required) (please affix photograph for ISD facility) : STD ISD CLI Hotline Conferencing Call Forwarding Hunting facility Abbreviated dialing 13.Whether Telephone instrument is required: Y/N 14. Whether Internal Wiring is required: Y/N 14 A. Whether the telephone is to be included in National Do not call (NDNC) registry Y/N (Please refer to instruction 10 overleaf) [please see instruction No.3(b)] [please see instruction No.3(b)] 15. Mention the tariff package required: [Please see various tariff packages available] 16. Payment Mode: Cash Demand Draft Amount Payment Details: DD No. Dated Drawn On: Bank Branch I hereby declare that information given above is true to the best of my knowledge and I will abide by the prevailing Telegraph Act/ Rules framed thereunder & Tariffs as amended from time to time. I am not a defaulter on account of non- payment of bills for any telecom services provided by any service provider. In the event of any dispute concerning any telecom line, apparatus or appliance, bill etc., between me/us and BSNL, the matter will be referred to the sole Arbitrator, appointed by a nominated authority in BSNL and shall be governed by the provisions of the Arbitration and Conciliation Act, 1996. Signature of Customer/ Authorized Signatory Signature of Customer/ Authorized Signatory Signed on: Date INSTRUCTIONS FOR FILLING THE FORM FOR NEW TELEPHONE CONNECTION 1. The form may be filled up in Capital letters only. 2. In the absence of PAN/GIR number, declaration in form 60/61 may be furnished in the enclosed proforma. 3(a) If Customer requires more than one telephone in the same name, Category and for installation at the same place, he/she may indicate here no. of telephone required. 3(b) A rebate is admissible on installation charges, if the telephone instrument and/ or internal wiring is arranged by the subscriber. 4. In case of sole proprietary concern, proprietor may sign himself and affix rubber stamp. 5. In case of partnership concern, all partners or any one of the partners duly authorised or Person with the Power of Attorney may sign. In case of Company, signature should be of a person on behalf of a Company, in accordance with the provisions of its Articles of Association. In case of partnership concerns, copy of (i) Power of attorney for authorization & (ii) Partnership Deed , and In case of Limited Company, a copy of the Articles of Association, may be attached. 6. In case of Government Departments, authorised person may sign and affix rubber stamp. 7. Relevant Documents should be duly attested by Central/ State Government Officers in respect of Concessional Groups and Special Categories indicted below. 8. For ISDN Connections, the customer is required to fill up a separate form. 9. If at any stage information furnished is found false - Telecom Service/ Telephone provided is liable to be disconnected immediately without any notice. 10. If you want your telephone to be included in National Donot Call (NDNC) registry (to prevent unsolicited commercial calls on your telephone) mark Yes in column 14A otherwise mark No 11. Categories Code: N-OYT-Gen 01 N-OYT-Spl 02 N-OYT-SS 03 N-OYT-G-SWS 04 N-OYT_G-SE-DoT 05 OYT-Gen. 06 OYT-Spl 07 TATKAL 08 Others 09 12. Concessional Group Code: Freedom Fighters 01 Gallantry Award Winners/ Awardees of President's Police Medal for Gallantry 02 War Widows 03 Disabled Soldiers 04 Blind 05 Senior Citizens 06 Retired DoT Employees 07 Serving DoT Employees 08 Recognized Educational Institutes 09 Orphanages 10 Others* 11 *Homes for aged, infirm, spastics, handicapped, deaf-dumb-mute persons/ voluntary organizations for tribal welfare and other like institutions recognized by Government 13. Applicable registration fee for various Categories is as under: Registration Fee Subject to Revision as per BSNL Rules Telephone Categories Urban Area Rural Area N-OYT-General/ Special/ SS Rs.2000/- Rs.500/- N-OYT-G-SE-DoT/ SWS Nil Nil OYT-General/ Special Rs.15000/- Rs.10000 & Rs.8000/- TATKAL Rs.30000/- Rs.30000/- 14. Description of Categories, entitlement and documents required: Category Entitled Persons/ Organizations Documents to be Attached (duly attested by Central/State Govt. Gazetted Officers) Doctors/ Nurses/ Midwives Recognized Degree/ Diploma, Registration Certificate. Press Accrediation Certificate from PIB Advocates & Judicial Officers Regn. By Bar Council [for advocates] Eminent Persons Proof of Recognition at State/ National Level in any field. Senior Citizens (aged 65+) Proof of age. Gallantry Award Winners Copy of Award Letter. War Widows/ Disabled Soldiers Documentary Evidence, Copy of PPO [for War Widows] Blind Persons Visually Blind Certificate from CMO News Papers Registration with the Registrar of News Paper Small Scale Industries SSI Registration Certificate N-OYT-Special Other Eligible Categories Documentary Proof. N-OYT-SWS Freedom Fignters/ Swatantra Senani Copy of PPO & I-Card N-OYT-SS MPs/ MLAs/ Municipal Counselors/ Presidents, Vice- Presidents, Chairman of Standing Committees of Distt., Block and Gram Panchayats and Members of Zila Parishads Foreign Missions and Embassies/ UN Organisations Distinguished Persons/ *Retired Govt. Officers, Staff & Officers of courts/ Retired DoT employees** * Subject to fulfilment of pay conditions and submission of documentary proof **Service Certificate, Service Book Entry Proof. N-OYT-G-SE-DoT Serving DoT employees Service Certificate, Service Book Entry Proof. OYT-Special Retd. Officers of PSUs, Statutory Bodies and Foreign Exchange Earners/ NRIs 15. Applicable charges for concessional Groups Concessional Group Registration charges Rental charges Installation charges Remarks Freedom Fighters NIL 50% of normal rentals NIL Same concession applicable to Widows of Freedom Fighters Gallantry Award Winners NIL NIL NIL NIL Awardees for President's Police Medal for Gallantry NIL NIL NIL War Widows/ Disabled Soldiers NIL 50% of normal rentals NIL Blind Persons Full charges 50% of normal rentals Full charges 50% of Annual Advance Rental Sr.Citizens NIL Full rentals Full charges Transferable in the name of spouse after death in General Category Retired DoT employees NIL NIL Full charges where actual installation is involved Free calls Group A-1000 | Free calls Group B- 500 | + admissible Group C- 300 | to normal Group D- 200 | subscribers Serving DoT employees NIL NIL NIL Free calls as admissible to normal subscribers Recognized Educational Institutions Full charges 75% of normal rentals Full charges Concession applicable on maximum 2 connections NOTE: RATES / TARIFF IS SUBJECT TO CHAGNE WITHOUT NOTICE.
