MAHANAGAR TELEPHONE NIGAM LIMITED, DELHI
Application for IN Services

For Office Use Only Free of Cost
Application No. IN Date of issue.
(DDMMYYYY)
C.A. NO. Telephone Exchange ___________________________
Note: Please read instructions before filling application form
FACILITIES REQUIRED TOLL FREE SERVICE (TFS)/PREMIUM RATE SERVICE (PRM)
1. Name of Applicant.
(Surname First Name Second Name)
2. Name of father/ husband/guardian.
(in case of individual) (Surname First Name Second Name)
3. Purpose of use. Residential / Business / Government /others (specify)
4. Status of applicant. Govt / PSU / Pvt / Individual/others (specify)
5. Payment particulars.
Amount Rs.
PO/DD No. Dated.
(DDMMYYYY)
Bank & Branch.
6. Address for correspondence.
PIN
7. Contact Telephone Number (if any)
E-mail ID
8. Billing address:
PIN
9. If the applicant is a Partnership Firm or Hindu Undivided Family (HUF), please furnish the following
Name of the Karta of HUF_________________________________________
Name in full of members of HUF/Partnership Firm Father's Name Relation to Karta
S.No. Name of members of HUF/Partnership Firm Father's Name Relation to Karta
Note : For any further queries, Please contact 1800 11 3435 ( Toll Free) ot visit http://mtnldelhi.in10. Nominee
S.No. Name Relation Address
11. EXISTING NUMBER & ADDRESS ON WHICH TFS/PRM Telephone No.IS REQUIRED.
Telephone No. 1
2
3
4
Address.
PIN
12. Accessibility required from Delhi National
13. TIME DEPENDENT ROUTING INFORMATION (Please attach a separate sheet if required)
(Applicable for 07 days a week)
S. No. Telephone No. Address Time Slot From To
14. ORIGIN DEPENDENT ROUTING INFORMATION (Please attach a separate sheet if required)
S.No. Telephone No. Address
15. CALL FORWARDING INFORMATION
S.No. Telephone No. Address Conditions
Busy
No Reply
OTHER DETAILS
16. ADDITIONAL DETAIL BILLS WHETHER REQUIRED Y N
17. Declaration.
I/We undertake to pay all call charges received on the Toll Free Number to be allotted to me /us.
Date: _________________ Place:_______________ (Signature with stamp)
Name (in Block letters) _____________________________
Note : For any further queries, Please contact 1800 11 3435 ( Toll Free) ot visit http://mtnldelhi.in
I/We agree to abide by the provision of Indian Telegraph Rules in force and as also such amendments as may be. made from time to time to these rules, in so far as they relate to this IN connection now or at a later date. I further confirm that all the telephone numbers are given in the form above for TFS/PRM service belong to me/us.Any dispute arising out to thesenumbers, responsibility shall rest on me/us. The Minimum hire period of Toll Free number is three months.