ISP-III
MAHANAGAR TELEPHONE NIGAM LIMITED,DELHI

APPLICATION FORM FOR MISCELLANEOUS INTERNET ACCESS SERVICE

FOR OFFICE USE ONLY
Booking Date -------------
Signature------------
FOR HELPDESK USE
Execution Date---------
Signature--------------
1.Name of the Applicant -------------------------------------------
2.User/Login ID ------------------------------------------------
3.Address, Contact No. ------------------------------------------
4.Miscellaneous Services opted:
a)Change of login id (1)-----------------(2)---------------------
b)Additional/Mail memory ----------(MB)
c)Additional personal Web space ----------(MB)
d)Additional email id (1)-----------------(2) ---------------------
e)Fixed IP access PSTN ISDN
5.Payment particulars :
Cash /DD No.--------------------- Date------------------------Amount----------------
Bank Name ------------------------------- Branch ----------------------------------
Date :---------- Signature of Applicant
RECEIPT
Recieved from Mr./Ms-------------------------------------------------------------------------
Rs.------ -(In words,Rs.---------------------------------------------------------------------)
Vide Cash/DD No.-------------------------------------- Dated------------------------------
Drawn on ------------------------------------------------------(Bank's Name & Branch)
Customer Code-----------------------
Signature