BHARAT SANCHAR NIGAM LIMITED (http://www.bsnl.co.in) FORM FOR ADD ON FACILITY [OPENING / CLOSING] Affix self signed passport size photograph (required for ISD facility only) 1. Telephone Number : 2. Name of the Customer (in Capital Letters) SURNAME FIRST 3. Address where the telephone is working House No Street/ Road/ Village Bldg./Appt. Area/ Locality/ Tehsil City/ District Pin 4.A Facilities to be opened: STD ISD CLI Hotline Conferencing Abbreviated Dialing Any Other 4.B Facilities to be closed: STD ISD CLI Hotline Conferencing Abbreviated Dialing Any Other I agree to pay the prescribed charges, as amended from time to time. Signature of Customer/ Authorised Signatory Signed on: Date Instructions 1. For CLI facility equipment has to be arranged by the customer which should be TEC approved. Rs.50/- per month is payable for this facility in addition to processing fee of Rs.50/- for every request for provision/ closure of the facility. 2. Additional Charges are payable for Abbreviated Dialing, Call Transfer, Hotline Facility and Conferencing Facility. The Applicable Charges are Rs.20/- per month per facility or a total sum of Rs.60 per month will be charged for availing the four facilities simultaneously.