Bharat Sanchar Nigam Limited
(A [Link] india Enterprise)
Application From For Closure /Surrender of Telephone
[Link] of the subscriber : ……………………………………………………………………………….
[Link] Number :……………………………………………………………………………….
[Link] of Telephone : Basic/FWT/WLL
[Link] Where telephone is installed :……………………………………………………………………………….
………………………………………………………………………………..
[Link] from which telephone is :………………………………………………………………………………….
Required to be closed
[Link] for surrender of telephone : (please tick the appropriate reasons as given below)
a. Moving to some other city
[Link] a mobile connection from BSNL in place of
Landline connection
[Link] constraints
[Link] of Business
[Link] satisfied with BSNL Service on account of
i) Billing Problems
ii) Commercial problems
iii) Frequent faults
iv) Improper behavior by BSNL staff
(please give details)
h)Any other reasons (please Specify)
[Link] on which refund of security :……………………………………………………………………………………………..
Deposit after adjustment of outstanding ……………………………………………………………………………………………..
Bill/amount should be sent ………………………………………………………………………………………………
[Link] Telephone No :………………………………………………………………………………………………
I undertake to pay any amount due to BSNL even after closure of telephone connection
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…………………………………
Signature of the officer/ official with seal