
Video Conferencing Application Form |
|
Please fill in the following information to avail Video Conferencing service (Fields marked with * are mandatory fields) |
|
|
||||||||||
|
Subscriber Details |
||||||||||
|
* Title |
Mr/Mrs/Miss |
* First Name |
|
|||||||
|
Middle Name |
|
Last Name |
|
|||||||
|
*Billing Address |
|
|||||||||
|
*City |
|
*State |
|
|||||||
|
*Country |
|
* Pin Code |
|
|||||||
|
*Existing BSNL No. |
|
|||||||||
|
Residence No. |
|
Office No. |
|
Mobile No. |
|
|||||
|
Email Address |
|
|||||||||
|
I have gone through the terms and conditions and abide by the same. *(Yes / No) |
||||||||||
|
-------For Official Use Only------- |
||||||||||
|
------To be filled by Customer Service Center------- |
||||||||||
|
Received (Rs) |
|
By (Tick one) |
Cash/Check/DD |
|||||||
|
Cheque/DD No |
|
Dated |
|
Drawee Bank |
|
|||||
|
Circle |
|
Town/City/SSA |
|
|||||||
|
Received Date |
|
Received By |
|
|||||||
|
------To be filled by Commercial Section------------ |
||||||||||
|
Status of the Application (Tick one) |
Accepted/Rejected |
|||||||||
|
If Accepted, Transaction No. |
|
|||||||||
|
If Rejected, Reason for rejection |
|
|||||||||
|
Date |
|
Updated By |
|
|||||||
|
-------Subscriber’s Copy-------- |
||||||||||
|
Received (Rs) |
|
By (Tick one) |
Cash/Check/DD |
|||||||
|
Cheque/DD No |
|
Dated |
|
Drawee Bank |
|
|||||
|
Circle |
|
Town/City/SSA |
|
|||||||
|
Received Date |
|
Received By |
|
|||||||
Date: ___/___/______ (DD/MM/YYYY) Signature: ___________________________
Place: ___________________________
Note: To view terms and conditions turn overleaf.
Terms and Conditions
GENERAL:
OTHERS:
RIGHT TO TERMINATE SERVICES:
DISCLAIMER: