APPLICATION FOR MPLS-VPN CIRCUITS

Date of Application____________
To,
The Commercial Officer
------------------------------
------------------------------
1. Name of person/company and address
(in whose name VPN is required) _______________________________________________
________________________________________________________________________
________________________________________________________________________
2. PAN/GIR.No._____________
3. Name of Liaison officer ____________________________________________________
and billing address _________________________________________________________
_________________________________________________________________________
__________________________________________ E-mail ID_______________________
Telephone No: __________________________ FAX No: ___________________________
4. Name of Technical Contact person/designation____________________________________
Complete address____________________________________________________________
___________________________________________________________________________
_____________________TelephoneNo:____________________Mob.No._______________
Fax ________________________________ E-mail ID______________________________
5. Status of the applicant: (Please tick relevant item) :
i) Individual ii) Public Sector undertaking
iii) Government iv) Public Institution
v) Statutory Body vi) Society/Trust
vii) Limited Co. viii) Others
(Please specify)
6. Applications proposed on VPN ( Please tick relevant item):
Data & file transfer Voice over IP Video Conferencing
1
Video Streaming Any other (Please specify) _________________ 2
7.
7.1 Technical information:-
S.No. Technical Details VPN Site A VPN Site B VPN Site C **
1 Address of site
2 Class of service
*3.1 Type and make of
modem
*3.2 Speed
*3.3 Modem interface
G703/V.35/Ethernet
4 Encapsulation
PPP/HDLC/Ethernet
5 Bandwidth
required
*-- For subscriber owned modem
** if more than three nodes are required please attach details for each site
7.2 Any other relevant information applicant wants to state:___________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
8. FOLLOWING DOCUMENTS ARE REQUIRED TO BE ATTACHED WITH FORM.
a. INDIVIDUAL/Proprietor-ship:-
i) Identity proof like Voter ID/driving license/passport etc. .
ii) Address Proof like Tel Bill/ Water/ Elect. Bill/house tax receipt
iii) Copy of PAN card/Form –60
iv) Rubber stamp of the Proprietor at all places(in case of proprietor- ship)
b. COMPANY:-
i) Resolution in favour of signatory or POA
ii) Memorandum of Articles and article of association
iii) Certificate of Incorporation.
iv) Attested true copy of valid RBI Permission(in case of foreign company)
c. In case of PARTNERSHIP: -
i) Attested True copy of Partnership deed with Form A
ii) Power of Attorney of the signatory with address proof
d. For all applicants : -
i) VPN Topology diagram.
Place________ Signature_________________
Date________ Name____________________
Tel.No. ________________. 3
DECLARATION
i) I/we hereby agree to abide by the provisions of Indian Telegraph Act 1885, Indian
Telegraph Rules 1951 & Information Technology Act 2000, in force and as modified
from time to time and such other terms and conditions prescribed by the telegraph
Authority/TRAI /MTNL. 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/TRAI
/MTNL. I/We further agree to extend facility to the Telegraph authority/TRAI /MTNL
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/Advances annual rental/
Wiring at customer premises /Arrears, VPN charges for all sites if any will be paid to
the controlling/billing authority. MTNL, __Delhi/Mumbai_ in a stipulated time on
receipt of demand note.
iii) I/We agree to pay the cancellation charges or other expenses incurred to establish the
circuit on my/our request 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 as specified by the
MTNL.
v) I/We declare that the information filled up by me/us in the form is correct and no
information has been concealed/ suppressed. If the information is found incorrect
subsequently, MTNL will have the right to take any action as deemed fit including
denial/termination of service.
vi) I/We have read and understood the terms and conditions for provisioning of MPLS
VPN. I/We shall/will not indulge in any activity that may result into any damage to
MTNL Network. I/We will take full ownership of the content transferred over VPN
services offered by MTNL. MTNL will not be responsible in any case for the content
transferred over VPN. I/We also agree to abide by the terms and conditions in force
from time to time by various security agencies of Govt. of India.
vii) I/we understand and agree that, MTNL reserves the rights to suspend/ disconnect the
services without assigning any reasons.
viii) I/we understand and agree that, Company/Individual (As applicable) will be
responsible for payment of VPN charges in respect of all VPN sites.
PLACE:-_____________ Signature
DATE:-______________ (Authorized signatory)
Name________________
Tel. No.______________ 4
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 No.60. may be furnished in
the enclosed Performa.
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 partner 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.
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 person will ensure
payment in respect of all billing sites.
___________________________________________________________________________
FOR OFFICE USE
For commercial Official use
1. Demand Note No.__________________________ Date __________________________
2. Amount Rs _____________________________________________________________
3. Mode of Payment: ______________ Cash/ Cheque(Name of the Bank)___________
(Cheque No________________ Date________
4. VPN ID Allotted _______________________________________________________
5. Date of Commissioning____________________________________________________
6. Frequency of payment (yearly/quarterly) ____________________________________
7. Account Manager (with Name and Designations)
MTNL NODAL OFFICER 5
For NOC Use:
Router site/E1 /Port no/Time Slot (For Channelized E1)______________
(To be indicated for each site)___________________________________
WAN IP Address / Subnet Mask_________________________________
VPN NAME ______________________
RD VALUE ______________________ RT VALUE __________________
CE-PE PROTOCOL: (Static/OSPF/RIP)_________________________________
MTNL MPLS (NOC) OFFICER