WorkOrderFormforStaticIP&AdditionalStaticIP(ILL/VILL/Retailplansopting

forstaticIPcustomersonly)
CustomerDetails:
CustomerName:
Address:

AccountDetails:
Serviceid(Userid):_________________BAN:________________ServicePlan:________________

[A]StaticIPDetails:
a. AllottedStaticIPpool:_________
b. DetailsofCustomerPremiseTerminatingequipment(CPE):
Router/Firewall/Server/Switch/TikonaCPE/otherpleasespecify_________________
i. CPEmake:
________________
ii. CPEmodelnumber:________________
iii. WANMACaddress:________________
c. TypeofSolutionBridge/NAT(Pleasetickawhereapplicable)

[B]AdditionalStaticIPDetails:

AdditionalStaticIPneeded:____(PleasestatenumberofIPsneeded,options1or5or13)

ReasonforusageofStaticIP:WebHosting/Mail/FTP/Others____________________(pleasespecify)

AllottedStaticIPpool:____________________________(tobefilledbySAMafterStaticIPallocation)

EquipmentDetails:(tobemadeavailableforallequipmentonwhichStaticIPisbeingused)
Sr.No
1
2
3
4
5
6
7
8
9
10
11
12
13

Devicetype

DeviceMakeandModel

DeviceMACaddress

AssignedIPaddress

a. LANdiagramofcustomersnetworkwhereStaticIPimplementationisrequired(pleasedraw
below):

Notes:
1. IfStaticIPisrequiredoncustomersdevice(e.g.Router,Firewalletc)thenpleaseshareitsWAN
portMACAddress.
2. StaticIPcanbeprovidedonlyonlayer3device.
3. StaticIPareallocatedinpoolsof4,8and16andusablestaticIPsare1,5and13respectively

CustomerDeclaration:
1. InternetTelephony:Internettelephonymeansaservicetoprocessandcarryvoicesignals
offeredthroughpublicinternetbyuseofPersonalcomputers(PC)orIPbasedcustomerPremise
equipment(CPE)connectingthefollowing:
a.PCtoPC;withinoroutsideIndia
b.PC/adevice/adapterconformingtostandardsofInternationalagencieslikeITU,IETFetc;in
IndiatoPSTN/PLMNabroad
c.Anydevice/adapterconformingtostandardsofInternationalagencieslikeITU,IETFetc;
connectedtoISPnodewithstaticIPaddresstosimilardevice/adapter;withinoroutsideIndia
2. Theinternettelephonydescribedincondition1.Aboveisonlypermitted
3. AddressingschemeforInternettelephonyshallonlyconformtoIPaddressingschemeof
InternetAssignedNumbersAuthority(IANA)exclusiveofNationalNumberingScheme/plan
applicabletoBasic/CellularTelephoneservice.TranslationofE.164number/privatenumberto
IPaddressallottedtoanydeviceandviceversa,toshowcompliancewithIANAnumbering
schemeisnotpermitted
4. CustomeracknowledgesthatVoIPwillnotbeusedinanyformotherthanwhatispermissible
undertheInternetserviceslicense.
5. CustomeracknowledgesthattheIPgivenwillnotbeusedforterminatingVoIPcallson
domesticPSTNnetwork.

Name:

____________________________________________________________
ServiceAssuranceManager

CustomerAuthorizedsignatory

Signatures&Stamp:

____________________________________________________________
ServiceAssuranceManager

CustomerAuthorizedsignatory