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BHARAT SANCHAR NIGAM LIMITEDCALCUTTA TELEPHONES

(http://www.bsnl.co.in/ or http://www.calcuttatelephones.com ) APPLICATION FORM FOR BROAD BAND SERVICE (DATA ONE) (For existing BSNL customers only)

Existing BSNL elephone No. on which Broa! Ban! connection is re"uire!:(#in!ly enclose the copy o$ the latest telephone bill)

%. itle/Name o$ the &ustomer/&ompany/Firm/'rgani ation (S *N+,E F-*S )

. &ontact el No: : ,ob: .Existing E0 ,ail a!!ress: 1111111111211111111111

3. ,o!em 'ptions: (See o4er lea$ $or tari$$ particulars 5 able 5 %

a) 6o you wish BSNL to 7ro4i!e ,o!em8 YES NO

b) -$ 9es then please tic; any one o$ the $ollowing options (i or ii ).

i) 'ption 5 % se BSNL ,o!em by 7aying +!4ance ,onthly *ental o$ *s %

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TERMS AND CONDITIONS Page-2

Applicants are requested to read the following terms and conditions before signing the application for Broadband Internet:GENERAL:1 Application form is free of cost !he form may be filled up in capital letters only" #ub$ect to the acceptance of the application and technical feasibility B#%& will endea'our to pro'ide the Broadband #er'ice as soon as possible

!he contract with B#%& for pro'ision of Broadband #er'ice will be for a minimum period from the date of commencement (depending upon the planchosen) in accordance with the tariff plan opted!he data rates shown as down streams or upstream is applicable only to last mile *owe'er B#%& does not hold responsibility for lesser download or

upload data rates caused by the accessed website status or the international gateway or the media+ Customers are free to choose their own ,odem of appro'ed models - All I. addresses assigned will be dynamic

/ !he Broadband connection is li0ely to be withdrawn in case the customer surrenders B#%& telephone lines#hifting of Broadband connection sub$ect to the technical feasibility would be done on payment of the applicable shifting charges

2 *ome users will be able to connect only one computer to the ,odem In case of business users3 it would be possible to connect more than onecomputer depending on the plan opted for

14 5ach home user can get atleast one email account 6ser name as per the preference indicated by customer would be allocated sub$ect to their a'ailability

11 !he subscriber is required to fully comply with the pro'isions of the Indian !elegraph Act 1 +3 Indian !elegraph 7ules and the Information!echnology Act "444 made there under and any amendments or replacements made thereto from time to time

PAYMENTSAt the time of issue of 8emand %ote3 following charges will be collecteda) Installation charges (As applicable) b) Ad'ance 7ental as per billing cycle (9ne month !wo months) ) #ecurity deposit of the modem (If Applicable) !) Ad'ance monthly rental for modem e) 7efundable security deposit for " months rental as per the plan (As applicable)") #er'ice !a;3 as applicable3 will be le'ied

Ot#e$ Con!ition%a For the 8IA# customers3 who are li0ely to switch to A8#& Broadband ser'ices3 the transfer of #ecurity 8eposit to A8#& is permitted

b Billing for the ser'ice will be included in the normal b of Application form) .articulars *ome .lan Business .lan

*ome +44 *ome1444

*ome1 44

*ome 44 Business1"44

Business444

Business+444

Business2444

Band width in ??? "+- @bps @bps +1" @bps 1 ,bps "+- @bps +1" @bps 1 ,bps " ,bps#ingle ,ulti 6ser (#6 ,6) #6 ,6 ,6 ,6,onthly Charges +44 1444 1 44 44 1"44 444 +444 24448iscounted Annual .ayment 9ption to Customers +444 14444 1 444 444 1"444 4444 +4444 244448ownload 6p load &imit) 1 4 B " B + B 14 B B 14 B "4 B 4 BAdditional 6sage Charges ,BBeyond free down load upload limit (7s)

" 4 1 +4 1 +4 1 +4 " 44 1 +4 1 +4 1 +4

Free e