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BHARAT SANCHAR NIGAM LIMITED (Website add: …

BHARAT SANCHAR NIGAM LIMITED (Website add: www.bsnl.co.in) APPLICATION FORM FOR CLOSURE/SURRENDER OF TELEPHONE 1. Name of the Subscriber : …

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Text of BHARAT SANCHAR NIGAM LIMITED (Website add: …

BHARAT SANCHAR NIGAM LIMITED (Website add: ) APPLICATION FORM FOR CLOSURE/SURRENDER OF TELEPHONE 1. Name of the Subscriber : ________________________________________ _____ 2. Telephone Number : ________________________________________ _____ 3. Account Number : ________________________________________ _____ 4. Type of Telephone : (i)Basic/WLL FWT (ii) WLL Mobile (iii)Cellular Mobile 5. Address of the subscriber : ________________________________________ _____ ---------------------------------------- ---------------------------- 6. Date from which the telephone is : ____________________ required to be closed 7. Reasons for surrender of telephone : 1. Moving to some other city/Mobile Licensed Service Area (Please tick the appropriate reason) 2. Being an additional phone, not required 3. Death of the original allottee 4. Financial constraints 5. Closure of business 6. Taking a Fixed/ Mobile connection from BSNL in place of Mobile/ Landline 7. Taking mobile/fixed telephone from other company 8. Not satisfied with BSNL s service on account of: a. Billing problems b. Commercial problems c. Frequent faults d. Improper behaviour by BSNL staff (Please give details) 9. Any other reasons (please specify):_________________ 8. Address on which refund of security : ________________________________________ _____ deposit after adjustment of outstanding ________________________________________ _____ bill/amount should be sent ________________________________________ _____ 9. Contact telephone No., if any : ___________________________ I undertake to pay any amount due to BSNL even after closure of the telephone connection. Signature of the customer Name:_________________ Receipt Received an application for closure of Fixed/ Mobile (Pre-paid or Post-paid)/ WLL(M)/FWT telephone connection working in the name of of receipt of application:_____________. Time of receipt ________________. Signature of the officer/ Official with seal

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