Nomination Form [For Individual applicants Other than Joint Applicants] I hereby nominate the person mentioned below who shall, in the event of my death, be entitled to get the telephone/ registration transferred through this form to his /her name or be entitled to be paid the amount of registration/security deposit for the telephone so registered in my name, to the exclusion of all other persons. (i) Name of the Nominee (In Block Letters) :________________________________________ (ii) Relationship with applicant :________________________________________ (ii) Full Address of the nominee (In Block Letters) : _________________________________________ (iv) In case nominee is a minor, please indicate Date of Birth of minor :___________________________________ Signature of the Nominee:_______________ Signature of Applicant :_______________ Name:________________________________ Name :_____________________________ Full Address: __________________________ Full Address:________________________ _________________________ ________________________ Witness 1 Signature: _________________________ Name : _________________________ Complete Address: ___________________________________________ ____________________________________________ 2. Signature: _________________________ Name : _________________________ Complete Address: ___________________________________________ _____________________________________________
