APPLICATION FORM FOR CLOSURE/SURRENDER OF TELEPHONE & BROADBAND Name of the Subscriber
:
_____________________________________________
Telephone Number
:
_____________________________________________
Type of Telephone
:
(i) Basic/ FWT (ii) WLL Mobile (iii) Cellular Mobile
Address where telephone is Installed
:
_____________________________________________
Date from which the telephone is required to be closed
:
_____________________________________________
Reasons for surrender of telephone (Please tick the appropriate reason)
Address on which refund of security Deposit after adjustment of outstanding Bill/amount should be sent
1. 2. 3. 4. 5. 6.
:
Moving to some other city. Being an additional phone, not required. Death of the original allottee. Financial constraints. Closure of Business. Taking a Mobile connection from BSNL in place of Landline Telephone . 7. Taking mobile/ fixed telephone from other company 8. Not satisfied with BSNL’s service on account of : (i) Billing problems. (ii) Commercial problems. (iii) Frequent faults. (iv) Improper behaviour by BSNL staff (Please give details) 9. Any other reasons (please specify) : _____________________________________________ _____________________________________________ _____________________________________________
Contact telephone No., if any : _____________________________________________ I undertake to pay any amount due to BSNL even after closure of the telephone connections.
Signature of the customer Name : _____________________
Receipt Received an application for closure w.e.f. ___________________________________ of Fixed Telephone Connection No. ____________________________________________________ working in the name of Shri/Smt/Ms _____________________ Date of receipt of application ______________________ Time of Receipt _________________________
Signature of the officer/ Official with seal. Page 1 of 1. Landline & Broadband closure form.pdf. Landline & Broadband closure form.pdf. Open. Extract. Open with.
i) Date of birth ii) Whether the applicant is a surrendered school teacher iii) Whether the applicant had opted to subscribe to the Fund after his/her 55th year. 3.
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Page 1 of 6. FORM J. [See rules 28(5), 39(1), (2) & (3)]. *APPLICATION FOR CLOSURE OF KASEPF (KERALA). 1. Name (in full), office address of Subscribe : account number and reference number. (as indicated in the latest annual account. statement receive
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followed by closing all these accounts bJ'.way of charging service charge of Rs. 20/- per year or if the. balance in account is below Rs.20/- the whole balance in ...
