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Form CAF

1. The document is an application form for broadband wireless service (WiMAX) from Bharat Sanchar Nigam Limited (BSNL), a government of India enterprise. 2. The application requests basic customer information like name, address, contact details, as well as service plan and equipment details. 3. By signing, the customer agrees to abide by BSNL's terms and conditions for the broadband wireless service.

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Thokchom Sonamani Singh
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88 views2 pages

Form CAF

1. The document is an application form for broadband wireless service (WiMAX) from Bharat Sanchar Nigam Limited (BSNL), a government of India enterprise. 2. The application requests basic customer information like name, address, contact details, as well as service plan and equipment details. 3. By signing, the customer agrees to abide by BSNL's terms and conditions for the broadband wireless service.

Uploaded by

Thokchom Sonamani Singh
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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BHARAT SANCHAR NIGAM LIMITED WiMAX

(A Govt. of India Enterprise)

APPLICATION FORM FOR BROADBAND WIRELESS SERVICE (WiMAX)


(Please fill the application form in capital letters only) YOUR DETAILS 1 Name of the Customer/Company/Firm/Organisation (Surname First) Mr/ Ms/Mrs/Dr Father's /Husband Name 2 Date of Birth 3 Gender Male Female

Self signed passport size photograph of Customer/ authorised signatory

4 PAN/GIR No. (In case PAN/GIR, is not there submit IT declaration in form 60/61) ( required in case if Individual) 5 Installation Address (Supported with Documentary Evidence-Refer Clause 2 overleaf) :

DISTRICT 6 Billing Address (In case other than installation address) :

PIN

TOWN 7 Purpose : Residence Business

PIN Govt PSU

8 Proof of Residential Address (Refer Clause 2 over leaf)) 9 Proof of Photo Identity (Refer Clause 3 over leaf)) 10 Contact No. 11 Email Address 12 Existing BSNL Customer 13 If Yes, Provide (a) Tel. No. & Address Yes Tele.

Mobile

No

(b) Last Bill Payment Details

Rs

Date

CHOOSE YOUR PLAN


1 2 3 4 USO CSC HOME BUSINESS

RWU 140 WCSC 400 HOWI 750 BUWI 1999

RWU 210 WCSC 1000 HOWI 1800 BUWI 3500 Single Type 1 (Without WiFi) MONTHLY BUWI 7000 Multi User Type 1 (With WiFi) ANNUALLY Out door USB Dongle WCSC 1500 If any other, specify -----------------------

5 Type of user : 6 Type of CPE required : 7 Bill Payment option :

* (for details of plan please see BSNL website http://www.bsnl.co.in or BSNL WiMAX leaflet/pamphlet) I / We 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 ammended from time to time.I/We am not a defaulter on account of non-payment of bills for any telecom services provided by any service provider. I have read and understood the terms & conditions provided overleaf to the form for Broad Band Wireless Services and accepted them as a binding on me. I/We have understood all rates, charges, tariffs and related terms & conditions at which telecommunications services are provided by BSNL as applicable on this date and as ammended from time to time. I/We confirm that the information(s)/particulars supplied by me is correct in all reaspect.
Signature of Customer/Authorised Signatory :

Date :

. FOR OFFICE USE ONLY A Date of receipt of Application B Franchisee/DSA code C AVCV by (Name) D CPE Make E CPE MAC ID F Date of activation G BSNL Account Number User ID : : : : : Mailbox ID Q B 1 0 0 0 Signature Model Received by

@bsnl.in

H CPE Label

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