___________ Telecom Circle
____________ Telecom Distt.

APPLICATION FOR MPLS-VPN CIRCUITS

(ONE APPLICATION PER VPN)
From (Applicant) To
_________________________ The Commercial Officer
_________________________ _________________________
_________________________
_________________________
Date of Application______________
1. Name of Company___________________________________________________________
2. Contact Person ______________________________________________________________
Complete Address___________________________________________________________
__________________________________________________________________________
Telephone No: ___________________ FAX No: ____________E-mail ID:______________
3. Billing Contact _____________________________________________________________
Address for correspondance____________________________________________________
___________________________________________________ E-mail ID:______________
Telephone No: __________________________ FAX No: ___________________________
4. Status of the applicant: (please tick relevant item)
i) Limited Co. ii) Public Sector undertaking
iii) Government iv) Public Institution
v) Statutory Body vi) Society/Trust
vii) Others
(Please specify)
5. Name of the cities where VPN is required. _______________________________
6. Type of connectivity required: Mesh connected / Hub and spoke _____________
(In case of “Hub and spoke” connectivity, indicate Hub location also)
VPN ID Allotted:
For official use only 7. Application proposed on VPN :
Data & file transfer Voice over IP Video Conferencing
Video Streaming Any other (Please specify)
8. Attach VPN topology diagram :
9. Technical Contact ___________________________________________________________
Complete address____________________________________________________________
___________________________________________________________________________
__________________________________Telephone No:___________________________
Fax ________________________________ E-mail ID______________________________
10. Any other relevant information the applicant wants to state.
___________________________________________________________________________
___________________________________________________________________________
11. Technical information:-
Fills in format attach at ‘Annexure A’ for each VPN site separately.
12. DECLARATION
i) I/we hereby agree to abide by the provisions of Indian Telegraph Rules in force and as
modified from time to time and such other terms and conditions prescribed by the
telegraph Authority/BSNL. I/We agree that the circuit will be used purely for
private/permitted application. It will not be used to carry voice/data or any other
communication, which is not permitted by the rules of Telegraph Authority/BSNL.
I/We further agree to extend facility to the Telegraph authority/BSNL in order to enable
monitoring of the purpose, performance and operation of the circuit, as and when
required.
ii) I/We agree that necessary charges for registration/installation/Advance annual
rental/Arrears if any will be paid to the controlling/billing authority. BSNL,
__________________ Telecom District as and when we receive demand note. As and
when such charges become due.
iii) I/We agree that i/We shall pay the cancellation charges and other expenses incurred to
establish the circuit as requested by me/us that may become payable, in the event of
cancellation of the application/closure of the circuit at a later date.
iv) I/we Agree to use the leased VPN circuit for the minimum period of hire as specified
by the BSNL.
v) I/We declare that the information filled up by me/us in the form is correct and no
information has been withheld. If the information is found incorrect subsequently,
BSNL will have the right to take any action deemed fit including denial/termination of
service.
vi) We have read and understood the term and conditions for provisioning of MPLS VPN.
We also agree and to abide by the terms and conditions in force from time to time
vii) BSNL reserves the rights to suspend/ disconnect the services without assigning any
reasons.
viii) Company will be responsible for payment of VPN charges in respect of all VPN sites. 13. Please mention list of enclosures:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Place________ __________________________
Date________ __________________________
__________________________
(Signature, Name & Address of the Applicant)14. Important instructions for filling up of the form:-
i) The form may be filled up in Capital letter only
ii) In the absence of PAN/GIR number, declaration in form 60/61 may be furnished in
the enclosed proforma.
iii) In case of sole proprietary concern, proprietor may sign himself and affix rubber
stamp.
iv) In case of partnership concern all partners or any one of the partners duly authorized
or Person with the Power of Attorney may sign. In case of company, signature should
be of a person on behalf of a Company in accordance with the provisions of its
Articles of Association. In case of Partnership concerns, copy of (I) power of
Attorney for authorization & (ii) Partnership Deed, and incase of Limited Company, a
copy of the Articles of Association may be attached.
v) In case of Government Department, Authorized person may sign and affix rubber
stamp.
vi) All sites of VPN must be in close user Group. The billing contact will ensure
payment in respect of all billing sites.
For Official use
1. Demand Note No.__________________________ Date __________________________
2. Amount Rs _____________________________________________________________
3. Mode of Payment : ______________ Cash/ Cheque
(Cheque No________________ Date________)
4. VPN ID Allotted._______________________________________________________
5. Date of Commissioning____________________________________________________
6. Frequency of payment (yearly/quarterly)____________________________________
7. Account Manager (with Name and Designations)
BSNL NODAL OFFICERAnnexure - A
Technical information:-
i) Name of City
ii) Complete address of contact person________________________________________
_____________________________________________________________________
__________________________________Telephone No:_______________________
Fax :______________________________E-mail ID :_________________________.
iii) Complete address of locations where VPN is required _______________________
_____________________________________________________________________
__________________________________Telephone No:_______________________
Fax :______________________________E-mail ID :_________________________
iv) Application proposed on VPN site :-
v) Application proposed on VPN :
Data & file transfer Voice over IP Video Conferencing
Video Streaming Any other (Please specify)
vi) Bandwidth Required ___________ Kbps/Mbps
vii) Type, make of modem and speed (if subscriber owned)______________________
viii) Modem interface : G703/V.35
ix) Class of Service: Gold / Silver/ Bronze
(Tick whichever is applicable)
viii) Encapsulation Type: PPP/HDLC/FR/Ethernet
(Tick whichever is applicable)
ix) Type of circuit 2-wire/ 4-wire____________________________________
(Tick whichever is applicable)
x) Details Of Customer Edge Router along with interface type (Model no &
Make):_______________________________________________________________
xi) Whether Router support ISDN termination.
xii) ISDN Dial back up: Yes/ No
(Separate application has to be filled for ISDN connectivities. ISDN connection and
user charges will be payable separately.)
xiii) Type of VPN required 1. L2VPN 2. L3VPN
xiii) In case of L3 VPN, following additional information is to be furnished.
· L3VPN details: (This information can be worked out in close associations of
BSNL representative)
LAN IP Address / Subnet Mask:___________________
Routing Protocols: Static / Dynamic
xiv) Specific requirement, if any__________________________________
For NOC Use:
Port Allotted / Time Slot (For Channelized E1) _______________
WAN IP Address / Subnet Mask ________________
(Kindly furnish the above information for all sites of VPN in separate Annexures)