BHARAT SANCHAR NIGAM LIMITED (www.bsnl.co.in ) FORM FOR SHIFTING OF TELEPHONE CONNECTION (Please read the instructions before filling the form) Inter City / Intra City Shift (please tick the option and strike off other) 1. Telephone Number to be Shifted: 2. Other Telephone No. working, if any: 3. Name of the Customer (in Capital Letters) SURNAME FIRST 4. Present Address where the telephone is working House No Street/ Road/ Village Bldg./Appt. Area/ Locality/ Tehsil City/ District Pin 5. Address where the telephone is to be shifted House No Street/ Road/ Village Bldg./Appt. Area/ Locality/ Tehsil City/ District Pin 6. Billing/ Correspondence Address (if different from 5 above) 7. E-mail address (if any) 8. Contact Tel. No. 9. Existing facilities working on the telephone 10. If the telephone shifting is not immediately feasible whether the Yes No telephone connection should continue to work at its present address 11. If no, date on which telephone is required to be disconnected: 12. Whether internal wiring will be provided by you at new place: Yes (Minimum 3 working days notice is required) No Signature of Customer/ Authorized Signatory Signed on: Date
