MAHANAGAR TELEPHONE NIGAM LIMITED
Website address :  http://www.mtnl.net.in
ORDER - FORM FOR NEW PRIMARY RATE ACCESS (PRA)
(Please read the instruction at back before filling the form)

1.   A. Title/Name of the customer/Company/Firm/Organisation (SURNAME FIRST)
     
2.   B. Name of Father/Husband/Group/Proprietor/Partner(s)
     

     
3.    Existing working connection:
         Telephone Nos.    1.MTNL ______________________  2. Others_________________________
4.    Complete installation Address
       Flat No.                                    Floor                                            Plot No.
       Building  
       Street                                                         Locality
       City                                                            Pin
5.    Proof of identity attached________________________
        (See instruction No. 5)
6.    Billing/Correspondence Address (if different from 4 above)
        Flat No.                                    Floor                                      Plot No.   
        building
        Street                                                        Locality
        City                                                            Pin
7.    E-mail address (if any)__________________________________ @________________________________
8.    Category :    Residence            Business            Govt.            PSU                Statutory body
9.    Additional facilities required (tick whichever is required):
        1.STD              2.ISD           3.Conferencing                4.DID                5.Incoming with data only     
        6.Both way data             7.Both way speech            8.Both way speech & data     
        9.Incoming   with data speech
10.    Number of MSNs required
11.    PAN (Please see instructions at Sl.no.)
12.    PAYMENT MODE :    Amount
        (if any)
        Payment details: DD No.                                    Dated
        Drawn on   
        Branch
    DECLARATION
    I hereby declare that the information given above is true to the best of my knowledge and I will abide by prevailing telegraph Act/Rules framed thereunder &Tariffs as amended from time to time. I am not a defaulter on account of non-payment of bill for any telecom service provided by MTNL. In the event of any dispute concerning any telecom line, apparatus or appliance, service, bill etc. between me/us and MTNL, the matter will be referred to the arbitrator, appointed by a nominated authority in MTNL,and shall be governed by the provisions of the Arbitration and Conciliation Act. 1996.

Signature of Customer / Authorized Signatory                         Signature of Customer/Authorized Signatory

Date :

INSTRUCTIONS FOR FILLING THE FORM FOR PRA CONNECTION

1.    The form may be filled in capital letters only. Separate form for each PRA connections may be filled up.
2.    In case of sole proprietory concern, proprietor may sign himself and affix rubber stamp.
3.    In case of Partnership concern, all partners or any one of the partners or any one of the partners duly         authorized or person with the Power of Attorney may sign. In case of Company signature should be of an authorized person on behalf of Company, in accordance  with the provisions of its articles of association. In case of partnership concerns, copy of (i) Power of attorney for authorization & (ii) Partnership Deed and in case of Limited Company, a copy of the articles of association, may be attached.
4.     In case of Govt. Departments, authorized person may sign and affix rubber stamp.
5.    Please attach any documentary   proof of identity i.e. copy of ration card, passport, identity card issued by any   institution, telephone, electricity/water/gas bill or signatures of two telephone subscribes/ Govt. Servants etc. or an affidavit to this regard.
6.    If at any stage information furnished found false- Telecom service/PRA provided is liable to be disconnected immediately without any notice.
7.    PAN or Form 60 (if PAN is not allotted) along with address proof.
8.    Purpose for which PRI required (on the letter head of company singed by authorized person).
9.    Terminating details (on the letter head of company  singed by authorized person).
10.    Commercial user subscribes shall mean and include a person and/or establishment carrying on any trade, business or profession or any work in connection with or incidental or ancillary thereto.
11.    The present Tariff structure is given below :-
       (i)        Registration Fee                 :        Nil
        (ii)       Modem supply charge          :        Nil
      (iii)      Modem Testing Charge       :        Nil
      (iv)      Initial deposit                      :        Rs 15000/- (at the time of  registration of PRA)
      (v)      One time installation charge:       Rs 4000/-
      (vi)      Free Call                         :        Nil
      (vii)     AMC of Modem                 :       Nil
      (viii)     Per month rent                :        Rs 5000/-(irrespective of distance).
                                                                  One year advance rental is to be paid before issue of order
       (ix)      Minimum period of hire      :        one year

    Note    :    Customer should submit the DD of Rs. 15000/- in favour of MTNL, Delhi with application for new PRA connection.