ISP-II
MAHANAGAR TELEPHONE NIGAM LIMITED,DELHI
APPLICATION FORM FOR INTERNET ACCESS RENEWAL

FOR OFFICE USE ONLY
Password Reference No.-------------
Booking Date ---------- Signature--------
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FOR HELPDESK USE
Account Renewal Date------
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Signature--------------
1.Name of the Applicant -------------------------------------------
2.User/Login ID ------------------------------------------------
3.Address, Contact No. ------------------------------------------
4.RENEWAL OPTED :(Please tick your choice)
(a) Full Renewal
PSTN Dial up PSTN Unlimited
plan ISDN 64 Kbps ISDN 128 Kbps
100Hrs One Month 100 Hrs 100 Hrs
250 Hrs Three Months 250 Hrs 250 Hrs
500 Hrs Six Months 500 Hrs 500 Hrs
Twelve Months 1000 Hrs 1000 Hrs
5.Payment particulars :
Cash /DD No.--------------------- Date------------------------Amount----------------
Bank Name ------------------------------- Branch ----------------------------------
Date :---------- Signature of Applicant----------------
RECEIPT
Recieved from Mr./Ms----------------------------------------------------------------------
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Rs.------ -(In words,Rs.--------------------------------------------------------------------
-)
Vide Cash/DD No.-------------------------------------- Dated-----------------------------
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Drawn on ---------------------------------------------------------(Bank's Name &
Branch) Customer Code----------------------- Signature