MAHANAGAR TELEPHONE NIGAM LIMITED
ORDER - FORM FOR NEW TELEPHONE

(Please read the instruction at the back before filling the form)
A. APPLICANT PARTICULARS
1. A. Title/Name of the Customer (Last name First)/Company/Firm/Organization
2. B. Name of Father/Husband/Group/Proprietor/Partner(s)
3. Existing working connections including Mobile: MTNL Nos. ………..
Others: ………
4. Complete installation Address
Flat/Plot
No.
Floor Building
Street Locality
City N E W D E LH I
Pin1 1 0 0
(Copy of Proof of Identity and Residential Address to be attached (see instruction 7)
5. Billing/Correspondence Address (if different from 4 above)
Flat/Plot No. Floor Building
Street Locality
City N E W D E LH I
Pin1 1 0 0
6. E-mail address (if any) ………………………………@…………..
7. No. of new connections required 8. Subscriber Category
(See instruction 13) (Please write Code No. as indicated in instruction No.10)
9. Category: Residential Business Govt. PSU Statutory Body Any other
10. TARIFF PLAN OPTED (See instructions 9) :………………………
11. Whether subs.fitting (wiring) is required from MTNL Y/N
B. ADDITIONAL FACILITIES REQUIRED ( Tick whichever is required):
12. STD ISD Conferencing Call Forwarding Abbreviated dialling/Any other
13. Telephone instrument required: Normal CLIP Cordless with
CLIP
Answering M/c Not required from
MTNL
C. Payment Details: DD/Cheque No. Dated
Drawn on :
Branch: .
D.
14. Telephone No. of subscriber/ DSA Code recommending you for MTNL connection (Please see
instruction 11)
15. Your Contact No. : (State whether PP)
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16. Old Tel No. of come back Sub., if applicable (See
instruction 14)
17. Registration required in National Do Not Registry (free of cost) : Yes/No
E DECLARATION
I hereby declare that information given above is true to the best of my knowledge and I will abide by the prevailing Telegraph Act/Rules framed thereunder
& Tariffs as amended from time to time. I am not a defaulter on account of non-payment of bills for any telecom service provided by MTNL. In the event
of any dispute concerning any telecom line, apparatus or appliance, service, bill etc., between me/us and MTNL, the matter will be referred to the sole
Arbitrator, appointed by a nominated authority in MTNL, and shall be governed by the provisions of the Arbitration and Conciliation Act. 1996.
Signature of Customer/Authorised Signatory Signature of Customer/Authorised Signatory
Date :
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
ACKNOWLEDGEMENT/IDENTITY SLIP
(To be handed over by the applicant at the time of installation) (See instruction No. 12)
CA No.
Received from Shri/Smt. ………………………………………………………whose signature are given below, an application for new telephone
connection
(Signature of MTNL Officer/Official)
(Signature of subscriber) Dated at New Delhi………
INSTRUCTIONS FOR FILLING THE FORM FOR NEW TELEPHONE CONNECTION
1. The form may be filled up in Capital letters only.
2. A rebate is admissible on installation charges if the telephone instrument and/or internal wiring is arranged by the subscriber.
3. In case of sole proprietary concern, proprietor may sign himself and affix rubber stamp.
4. In case of Partnership concern, all partners or any one of the partners duly authorised or Person with the Power of Attorney may sign. In case of
Company, signature should be of a person on behalf of Company, in accordance with the provisions of its Articles of Association. In case of
Partnership concerns, copy of (i) Power of attorney for authorisation & (ii) Partnership Deed and in case of Limited Company, a copy of the articles of
association, may be attached.
5. In case of Govt. Departments, authorised person may sign and affix rubber stamp.
6. Relevant documents should be duly attested by Central /State Government Officers in respect of Concessional Groups and Special Categories
indicated against instruction in 10.
7. Submission of attested photocopies of any of the following documents shall be considered appropriate as proof of personal Identification and
address, as the case may be.
Attestation by a Gazetted Officer, Bank Manager, Notary or any authority authorised would be acceptable. In case of difficulty in getting attestation
the customer can bring originals with photocopies to the concerned Commercial Officer.
(i) Paid Telephone/Gas/Water/Electricity/Credit Card/House Tax bill receipt, allotment letter of accommodation issued by Estate
Office of the govt. of India/Govt. of Delhi, NDMC/MCD/DDA.
(ii) Income Tax Returns.
(iii) Election Identity Card issued by Election Commission of India.
(iv) Driving License.
(v) Passport.
(vi) Rent Receipt of rented house.
(vii) Notarized personal affidavit on Rs. 10/- Non judicial Stamp Paper declaring the address and profession of the applicant. (viii)
rent/Lease agreement.
8. If at any stage information furnished is found false - Telecom Service/Telephone provided is liable to be disconnected immediately without any
notice
9. A copy of the present tariff structure is enclosed. Please specify the tariff plan to be opted in item 11 of the application form. The Plan for either
voice or internet be indicated. The tariff applicable can be changed by MTNL without notice.
10. Subscriber Category, Concessions available and documents required (only if claiming concessional tariff) Concession is available only in
standard tariff plan, which at present is ‘Plan 250’.
S.N Subs
Catgry.
Entitled persons/organizations Concessions available Documents to be attached (duly attested
by Central/State Govt. Gazetted Officer)
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1. 01 Business Nil
2. 02 Residential Nil
3. 03 Non Residential Telephones in Schools /
Universities / Colleges / Institutions / Homes for
aged/orphanage etc. recognized by Govt.
25%
Concession in Rental
Recognition Certificate
4. 04 Blind persons 50%
Concession in Rental
Visually blind certificate from C.M.O. of
a Govt. Hospital.
5. 05 War Widows/Disabled soldiers 50%
Concession in Rental and no
installation charges.
Documentary evidence, copy of PP0 (for
war widows)
6. 06 Freedom Fighters 50%
Concession in Rental and no
Installation charges
Copy of PPO and identity Card.
7.. 07 Gallantry/President’s Police Medal for Gallantry
Awardees
No Rental and no. installation charges Copy of Award letter.
8. 08 Serving DOT employees Rent free with free calls as available to
normal subscribers
Service Certificate, Service Book entry
proof.
9. 09 Retired DOT employees No Rental and free calls as below:
Gr.A=1000+Normal Free Calls
Gr..B =500+Normal Free Calls
Gr.C = 300+Normal Free Calls Gr.D
=200 +Normal Free Calls
Copy of PPO and other documentary
Proof.
10. 10 Senior Citizen Rental Rs.187.50 Age above 65 Years. Age proof required
11. In case you were recommended by some existing subscriber of MTNL/DSA for the new connection being applied, Please indicate his Tel.No. or,
DSA code as the case may be, in item 14.
12. The tear off slip would be an identity proof & it should be made over to Line staff at the time of installation by the applicant.
13. In case of more than one connections, an additional proforma is required to be filled up
14. If you were an old MTNL customer, please write the number for Loyalty Points Award. Efforts will also be made to allot the same number, if feasible.
.
AFFIDAVIT
Performa for Notarized personal affidavit of Rs 10/- to be submitted by the subscriber as proof of address
I _________________________________S/O,D/O,W/o__________________________________________
resident of ________________________________________________________________________________
do hereby solemnly affirm and declare as under:
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1.That I am at present residing at _____________________________________________
2.That I am applying for a new telephone connection with MTNL for my residence /office at
___________________________________________________________________________________________
3.That telephone is for my bonafide use.
(Deponent)
Verification
Verified this on ________________________day_________________________of 2002,that the above contents of
this Affidavit are true and correct and nothing has been concealed therefrom.
(Deponent)
(To be attested by Notary Public with Notarial Stamps)
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Documents Required:-
a) Address proof: Attested copy of any of the following-Passport, latest paid telephone/Gas/water/
electricity/Credit Card/House Tax Bills receipt, Allotment letter of accommodation issued by Estate Office
of a Govt. Body, Income-Tax return, Election Card, Driving licence, Rent receipt/rent lease agreement./
Notarized personal affidavit in Rs 10/- of non judicial stamp paper declaring address & profession of
applicant.
b) Documents required for proof of identity Attested copy of any of the following:- Passport, Driving
licence, Election Card issued by Election Commission of India, PAN Card. Any Govt. document
containing photograph, identity card issued by Govt./Semi Govt./PSU/Recognized Institutions.OR
Self attested copy of above and present original document mentioned above for verification by the
MTNL Official at the booking counter.
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