CUSTOMER APPLICATION FORM
IPTV/VOD/MOD/KOD

(C) Installation Address:
Please fill this form in CAPITAL LETTERS in black ink only
(A) MTNL Subscriber ID (CA Number as printed in the bill):
MTNL Landline number on which BB is working & IPTV is required:
Other Landline numbers:
(B) Subscriber Profile:
Subscriber Name:
Gender: Male Female
PIN
(E) Select Your Package: (Your Service will be activated only after selecting a Package as addressed in ANNEXURE - 1)
Please note: Subscription to one Basic Package is compulsory. Prices of the Packages are subject to change.
Package Name. ______________________________.
Please sign this Subscription Terms & Conditions:
This Subscription Terms & Conditions (which includes this Subscription Form, the Terms and Conditions and the Work Order) is made between MTNL and You, the subscriber whose name appears above on this page and who is bound to the Subscription Terms & Conditions by the signature, which appears below: We will provide you with the service subject to the conditions of this Subscription Terms & Conditions.
(A) Your Contact Number / email:
Home Office Mobile
Email:
(F) I confirm that I have read and understood all conditions set out and I agree to abide by them.
dd mm yyyy
Signature __________________________ Date :
[This Subscription terms & conditions must be signed only by the subscriber or Your Authorised Representative.]
Mac Address of STB: Sr No:
(To be filled by MTNL / AKSH)CUSTOMER APPLICATION FORM IPTV/VOD/MOD/KOD

Acknowledgement Slip
Received booking for MTNL IPTV connection for Plan __________________________ on telephone No: _______________________
Date: __________________________ (Signatures of MTNL Official) ________________________CUSTOMER APPLICATION FORM IPTV/VOD/MOD/KOD

(A) TERMS & CONDITIONS: -
1. Booking will be confirmed subject to feasibility.
2. The applicant shall pay the registration fee deposit which will be charged in telephone bill.
3. MTNL shall have the sole discretion to accept or reject the application without assigning any reason. In case the application is rejected, the deposit shall be refunded to the applicant.
4. The STB and the accessories shall be solely used for availing IPTV services on Triband of MTNL and shall not be used for availing services of any other Network.
5. The Set Top Box and the accessories shall be used for viewing authorized channels, programs and services.
6. The subscriber shall take adequate care of the STB, during the period of the agreement. Any willful default or damage to STB will be in the account of the subscriber.
7. The subscriber shall not without the prior authorization of MTNL, remove, transfer or otherwise relocate the STB from the original place of installation, failing which the deposit shall be forfeited & MTNL shall be entitled to recover the cost of the box and / or initiate legal action
8. In case STB is lost or damaged on account of theft, burglary or by any other accident; the subscriber shall file a police complaint forthwith and notify MTNL of such loss immediately; failing which MTNL reserves the right to recover the cost of the STB from the subscriber.
9. In case of nonpayment / delay in payment of rentals. MTNL shall reserve the right to cancel / suspend the service and to discontinue the Services. In such cases, the subscriber shall return the STB in good working condition; failing which the deposit shall be adjusted towards the cost of STB.
10. The Pay Channel fees; as prescribed from time to time for each channel selected shall be paid.
11. The subscriber shall, in advance notify change of address / contact number to MTNL or its authorized representative for future correspondence / context.
12. In case the subscriber desires to discontinue the services, he shall return the STB in good working condition.
13. For reconnection / activation of the service earlier disconnected for any reason, the subscriber shall pay reconnection charges as prescribed from time to time.
14. IPTV services in respect of Pay Channels shall be available to the subscriber subject to Force Majeure conditions including but not limited to act of God, fires, strikes, embargoes, war insurrection, riots and other causes beyond the reasonable control of MTNL including atmospheric / topographical hindrances.
15. Subscriber/s are not authorized to install any Gadgets on STB without MTNL's prior written permission. The subscriber has to protect the STB.
16. Subscriber shall not be entitled to transfer or assign its obligations and liabilities under the terms and conditions to any other party under any circumstances without prior permission of MTNL. Any transfer affected in contravention of the expressed terms contained herein shall not absolve the Subscriber of its obligations /liability towards MTNL.
17. All taxes, levies etc. present and future shall be to the account of subscriber as applicable.
18. The tariff / charges for Pay Channels are based on Agreements with Pay Channels at the time of presentation of this form. In case of any change in these arrangements, additional applicable charges, shall be payable by the Subscriber.
19. The Subscriber shall make payment to MTNL against the bill raised by MTNL on or before the due date.
20. IPTV Service quality, functionality, availability and / or reliability may be affected and / or MTNL is entitled to, without any liability, refuse, limit, suspend, vary, disconnect and or interrupt the Services; in whole or in part, at any time in its sole discretion with respect to one / all Subscribers, without any notice or reasons.
21. In case of misuse of Services or breach of any terms and conditions by the subscriber or use of services by the subscriber in such a manner that it violates any laws or adversely affects or interferes with MTNL Service, Company shall give notice of five (5) days to the Subscriber to remedy the breach. In case the Subscriber fails to remedy the said breach within the notice period, MTNL shall be entitled to discontinue the Services forthwith.
22. MTNL at its sole discretion may suspend/ discontinue the Services by giving reasonable notice to Subscriber.
23. The IPTV service is liable for disconnection partially or otherwise due to:
a. Changes in the law, rules, regulations or orders, directions, notifications etc by the Authorities.
b. Physical obstruction, geographic, topographic, hydrological, meteorological and other causes of cable interference or faults in
other networks of Pay Channels to which the Network is connected.
c. Any discrepancies / wrong particulars provided by the Subscriber.
24. Any dispute or difference of any nature whatsoever or regarding any right, liability, act, omission on account of any of the parties hereto arising out of or in relation to this terms & conditions shall be settled by arbitration in accordance to MTNL. However subscriber has right to appeal to the next higher authority.
25. The validity, construction and performances of terms and conditions herein shall be governed by and interpreted in accordance with
prevailing laws. MTNL and Subscriber agree to submit to the exclusive jurisdiction of the Delhi Courts.
26. I hereby undertake that I will fully abide by Indian copyright Act 1994 and as amended from time to time. I will not indulge in pilferage/ copy of the content etc as prohibited by the law. In the event of any such violation, civil or criminal action may instituted for injunction, actual damages (including infringer’s profit) etc.
27. Availability of audio-in and Video-in ports in TV will be the sole responsibility of the subscriber(audio-in and Video-in ports are required for interfacing the STB).
28. The customer is required to fully comply with the provisions of the Indian Telegraph Act, 1885 and InformationTechnology (IT) Act, 2000 & the Indian Telegraph Rules made there under and any amendments or replacements made there to from time to time.
I /We have read and understood the terms and Conditions provided overleaf and acknowledge that the tariff plan selected and I agree to
be bound by the same. I /We agree to abide by the provisions of MTNL and the rules made there under and as also such amendments as may be made from time to time to these rules in so far as they relate to the Services. I/ We hereby declare and confirm that the aboveinformation provided by me / us is / are totally correct and true in every respect.
3 of 4CUSTOMER APPLICATION FORM IPTV/VOD/MOD/KOD
Aksh
Place: ___________________ Signature of Subscriber : ___________________________
Abbreviations: IPTV – Internet Protocol TV / VOD – Video On Demand / TSTV – Time Shift TV