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Old January 18th, 2017, 06:17 PM
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Join Date: May 2011
Default Re: Bharat Sanchar Nigam Limited Form

As you want to download application form to apply for Broadband Connection of Bharat Sanchar Nigam Limited, so here I am providing following form:

You have to fill following details on Application Form:

Existing BSNL Telephone No. on which Broadband connection is required:

Want to apply for a new connection: Yes No

Educational Qualification (Optional): Doctorate/Post Graduate/Graduate/Matriculate/Other

Title/Name of the Customer / Firm /Organization (SURNAME FIRST)

Billing Address:

Address of Connection (i.e. Installation Address):

Contact Tel. No.:
Resi
Off.:
Mob.:

E-Mail Address:
Broadband Service being applied for Prepaid □ Postpaid □
Modem Options (See tariff details)
Do you want BSNL to Provide Modem : Yes □ No

If Yes, then please tick any one of the following Options (i.e. A or B or C)
[ Type-I (Ethernet & One USB Port) ; Type-II (Ethernet & One Wi-Fi Port) ]

Option-1: Outright Modem Purchase from BSNL Type-I □ or Type-II □ (see conditions overleaf)

Option-2: Use BSNL Modem by paying Advance monthly Rental for Type-I or Type-II
& Refundable Security Deposit of Rs. 500/- (Applicable for Postpaid Broadband service only)

Option-3: Free Modem (Please see condition for providing free modem in tariff details) □
(Applicable for Postpaid Broadband service only):

Type of Broadband connection (See conditions overleaf) : Business Residential
(Applicable for Postpaid Broadband service only):

Choice of Tariff Plan :
(Applicable for Postpaid Broadband service only)

Recharge Options for the Prepaid Customers (see tariff details)
Payment option (Applicable for Postpaid Broadband service only): Monthly Annually

Choice of e-mail/user Ids

Nominee (Optional)

Customer signature

Franchisee Code, if any

Bharat Sanchar Nigam Limited Application Form for Broadband Connection


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