MAHANAGAR TELEPHONE NIGAM LIMITED

FORM FOR SURRENDER OF CONNECTION

1. Telephone Number
2. Name of the customer /company/organization(surname first)
3. Address where the telephone is working
Flat No. Floor. Plot
No.
Building
Street. Locality.
City. Pin.
4. Date on Which telephone is required to
be Closed :
5. Reasons for Closure
(Please tick the appropriate SL no.)
1. Taking all India shift
2. Shift within Mumbai
3. This is an additional telephone
4. Financial/Economic condition /closure of
company/Business.
5. Tariff high
6. Surrender of OYT Connection as tele.
Is available on
demand
7. Taking telephone from other
company.
8. Not satisfied with service
(a)Commercial
(b)Billing
(c)Any other reason
9. Any other reason (Pl.specify)
After adjustment of outstanding bills, balance Security if any may please be
refunded at the Address given below. I hereby undertake to pay any amount due
to MTNL, which comes to the notice even at a later date and after closure of
connection
Signature of Customer
Dated:______________
Address . ______________
(if different from 3 above)____________________________