Вы находитесь на странице: 1из 2

NEPAL TELECOM

passport size
photograph with
Customer
authorised
signature

(Nepal Doorsanchar Company Limited)


APPLICATION FORM
Broadband Wireless Service ( [ ] WiMAX [ ] Wifi )
1.

Customers Name (in BLOCK LETTERS):

2.

Customers Permanent Address:

Ward No

Zone

District

Installation Address:
Ward No
House No

Street Name

Zone

District

3.

House No

Street Name

4.

Customers Mobile:

5.

Customers Identity:

Citizenship

Number:

Passport

Tole Name

VDC/Municipality

Tole Name

VDC/Municipality

Email:
PAN

specify

Others

District:

6.

Name of Company/Firm/Organization:

7.

Company/Firm/Organizations Full Address:

8.

Customers ID:

9.

Type of CPE required:

Outdoor

Indoor

USB Dongle

10.

Packages:

256 Kbps

512 Kbps

1Mbps or above

11.

Type of User:

Single

Multiple

12.

Purpose:

Residence

Business

Site Map of the users premises from the Main Road ....

Government

Finger Prints

Distance of residence is ........ meters from nearest Main Road.

right

left

.......................................
Customer Signature
Date : 20 /
/

FOR OFFICE USE ONLY


A Application Received Date

B CPE Make

Receipt No
Model

C MAC CPE
D Date of activation
................................................
Signature
Name
Designation

E Vendor

g]kfn 6]lnsd / >L ===================================================================aLr ;DkGg ePsf]


;Demf}tf

g]kfn 6]lnsd - h;nfO{ o;kl5 sDkgL egL ;Daf]wg ul/Psf] 5 _ / >L ========================================== sf] gftLgftLgL, >L =========================== sf] 5f]/f5f]/L
>LdtL, =========================== lhNnf ================== dxfgu/kflnsf pkdxfgu/kflnsf/ gu/kflnsf uf=la=;=,a8f g+ ===== a:g] g]kfn 6]lnsd4f/f ljtl/t Wimax
Outdoor / Indoor/ USB Dongle sf] df]8]n g+ ==================================== sf u|fxs aif{ ======= sf] >L ============================= gf=k|=g+= =================== gf=k|=g+
ljt/0f ePsf] lhNNff =========================== - h;nfO{ o;kl5 u|fxs egL ;Daf]wg ul/Psf] 5 _ aLr ;]jf pkef]u ug]{u/fpg] p2Zon] lgDg pNn]lvt zt{x? kfngf ug{
b'a} kIf ;xdt e} b:tvt ;lx5fk u/L PsPs k|lt a'lem lnof}+,lbof}+ .



zt{x? M
!= ;]jf pkef]usf] nflu sDkgL4f/f ljls| ul/g] Wimax Outdoor/ Indoor/ USB Dongle sf] d'No sDkgLdf ;]6 df}Hbft /x] ;Dd,_ Activation Charge,
;+rfng dx;'n b/ tyf g]kfn ;/sf/n] tf]s] adf]lhdsf] s/ /sd u|fxsn] sDkgLdf a'emfpg' kg]{5 .
@= u|fxsnfO{ sDkgL4f/f ljls| u/]sf] ;]6df ljls| u/]sf] ldltn] # dlxgfsf] cjlwleq ;]6sf] pTkfbg v/fljsf] sf/0fn] u|fxssf] c;fjwfgLn] ubf{ pQm ;]6 6'6km'6 ePdf
jf x/fPsf] cj:yfdf sDkgLn] lgwf{/0f u/]sf] d'No u|fxsaf6 c;'n u/L gofF Wimax Outdoor/ Indoor/ USB Dongle pknAw u/fOg]5 .
#= pQm cjlw kZrft Wimax Outdoor/ Indoor/ USB Dongle h'g;'s} k|sf/sf] v/flj cfPdf klg sDkgLn] lgwf{/0f u/]sf] Wimax Outdoor/ Indoor/
USB Dongle sf] d'No u|fxsaf6 c;'n u/L gofF Wimax Outdoor/ Indoor/ USB Dongle pknAw u/fOg] 5 .
$= sDkgLaf6 Wimax Outdoor/ Indoor/ USB Dongle lnPsf u|fxsx?n] h'g 7]ufgf lnPsf] xf] ;f]xL 7]ufgf dfq pQm ;'lawf ;Frfng ug'{ kg]{5 .
%= Wimax Outdoor/ Indoor/ USB Dongle x/fPdf cljnDa ;DalGwt sfo{nodf lnlvt ;"rgf lbP/ ;]jf aGb u/fpg' kg]{5 . ;]jf k"gM ;+rfngsf] nflu j'Fbf
# cg';f/ dx;'n e'QmgL ug'{kg]{5 .
^ pkef]u u/]sf] ;]jf cj?4 ePdf u|fxsn] sDkgLsf] 6]lnkmf]g dd{t zfvfsf] tf]lsPsf] :yfgdf ;"rgf ug' kg]{ 5 . ;"rgf k|fKt kZrft\ sDkgLn] Fault kQf nufO{
cj?4 ;]jf cljnDa ;'rf? u/Lg]5 .
&= h'g;'s} k|of]hgsf] nflu ;]jf lnPsf] ePtf klg of] ;Demf}tfsf zt{, b"/;+rf/ P]g, lgod, gLlt Pj+ cGo k|rlnt sfg"gsf] k|lts'n x'g] ul/ u}/ sfg"gL tyf cglws[t
?kdf ;]jf k|of]u ePsf] kfOPdf sDkgLn] ;]jf aGb u/L k|rlnt P]g sfg"g cg';f/ sf/jfxL ug]{5 .
*= s'g} klg u|fxsn] lnPsf] ;]jf, ;'ljwf hf]];'s}n] k|of]u u/]sf] ePtf klg ;f] sf] lhDd]jf/L h;sf] gfddf btf{ ePsf] 5 ;f]xL u|fxsn] g} axg ug'{ kg]{5 .
( ;]jf;+u ;DjlGwt cGo yk ;'ljwfx? Tff]lsP adf]lhdsf] /sd a'emfO{ u|fxsn] dfu u/]sf] v08df Ifdtfn] EofP;Dd sDkgL4f/f pknAw u/fOg]5 .

!)= ;]jf;+u ;DalGwt sDkgLn] ljBdfg gLlt, lgod, ljlgod eljiodf x'g] kl/jt{g tyf eljiodf aGg] gofF gLlt, lgod, ljlgod ;DjlGwt lgsfosf] :jLs[lt k|fKt
ePkl5 ;fj{hlgs ;"rgf k|sflzt u/] kZrft pQm gLlt, lgod, ljlgodx? b'a} kIfnfO{ dfGo x'g] 5 To;nfO{ of] ;Demf}tfsf] cleGg cu+ dflgg] 5 .
!!= o; ;Demf}tfdf pNn]lvt zt{x? kl/jt{g tyf yk ug'{ k/]df g]kfn b"/;+rf/ k|flws/0fsf] :jLs[tL kZrft ;fj{hlgs ;"rgfaf6 yk jf kl/jt{g ug{ ;Sg]5 . o;/L
;"rgfaf6 yk ePsf zt{x? o; ;Demf}tfsf] cleGg cu+ dflgg] 5 t/ zt{ kl/jt{g ubf{ !% lbg cufj} u|fxsju{x?nfO{ ;"lrt ul/g] 5 .