BHARAT SANCHAR NIGAM LIMITED CALCUTTA 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 %<</0 = non0 re$un!able Security 6eposit o$ *s. ><</0

ii) 'ption 5 . ?? Free ,o!em ?? 'pt $or any o$ the $ollowing ari$$ 7lan an! a4ail mo!em F*EE. 7lan @ome %A<< @ome 33<< @ome 7lan &ommitte! 7erio! %. ,onths B ,onths 7lan Business Business Business Business Business 7lan &ommitte! 7erio! %A ,onths C ,onths B ,onths 3 ,onths

%.<< 3<<< ><<< C<<<

c) -$ N': the ,o!em use! by you shoul! be a stan!ar! +6SL ,o!em. D. ari$$ 'ptions (? ari$$ subEect to change without notice) (7lease tic; any one o$ the $ollowing an! $or instructions see able 5 . o$ o4erlea$) +. @ome: ><< %<<< %A<< ,onthly +nnually 33<<

B. &. %.<<

Payment Option
Business:

3<<<

><<< +nnually

C<<<

Payment Option

,onthly

>. &hoice $or user i!Fs: i)/////////////////////ii)////////////////////////iii)////// //////////// i4)////////////////// 4)/////////////////// 4i)/////////////////////// / Note: )ser -6 shoul! be o$ B to %< characters . For plan with one $ree e0mail i! 3 choices o$ user i! may be gi4en. )ser name is subEect to a4ailability. (-n case pre$erre! user name is not a4ailable BSNL will pro4i!e one user name generate! by the system) //////////////////////////////..//////////////////////////////..//// /////////////////////////// Franchisee Code (if any ): Signature o$ &ustomer/+uthorise! Signatory Signature o$ &ustomer/+uthorise! Signatory &ont!/7age .

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$ect to the acceptance of the application and technical feasibility B#%& will endea'our to pro'ide the Broadband #er'ice as soon as possible ( !he contract with B#%& for pro'ision of Broadband #er'ice will be for a minimum period from the date of commencement (depending upon the plan chosen) in accordance with the tariff plan opted ) !he data rates shown as down streams or upstream is applicable only to last mile *owe'er B#%& does not hold responsibility for lesser download or upload data rates caused by the accessed website status or the international gateway or the media + Customers are free to choose their own ,odem of appro'ed models All I. addresses assigned will be dynamic / !he Broadband connection is li0ely to be withdrawn in case the customer surrenders B#%& telephone lines 1 #hifting of Broadband connection sub$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 one computer 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$ect to their a'ailability 11 !he subscriber is required to fully comply with the pro'isions of the Indian !elegraph Act 111+3 Indian !elegraph 7ules and the Information !echnology Act "444 made there under and any amendments or replacements made thereto from time to time PAYMENTS At the time of issue of 8emand %ote3 following charges will be collected a) Installation charges (As applicable) b) Ad'ance 7ental as per billing cycle (9ne month : !wo months) ) #ecurity deposit of the modem (If Applicable) !) Ad'ance monthly rental for modem e) 7efundable security deposit for " months rental as per the plan (As applicable) ") #er'ice !a;3 as applicable3 will be le'ied Ot#e$ 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<fone bill !he billing cycle shall be same as b<fone billing cycle etc ,onthly rental will be collected in ad'ance and usage charges in arrears 1) %o migration is allowed to the lower tariff plan till the e;piry of the committed period RIG&T TO TERMINATE SER'ICE: 1 B#%& reser'es the right to disconnect the ser'ice to any customer in case there is sufficient e'idence of the customer intentionally or unintentionally using the ser'ice in a manner which would ad'ersely impact B#%& or B#%&=s %etwor0 " !he customer shall be responsible for using the ser'ice only for &egal and appropriate purposes ( B#%& reser'es the right to terminate the ser'ices in the e'ent of non<payment of bills preferred by B#%& in accordance with the tariff plans opted by the customer and the e;tent of usage or any default on the part of customers DISCLAIMER: 1 B#%& will e;ercise all reasonable care in pro'iding its ser'ices3 but it is not responsible for interruption:ser'ice due to power failures3 equipment malfunctions3 or acts of natural calamity " B#%& is not responsible for subscriber=s computer hardware and software or areas of the Internet not under its control B#%& does not warrant pri'acy3 security3 or efficiency of the Internet ( B#%& is not responsible for actions ta0en by its customers or others as a result of its ser'ices ) B#%& is not responsible for material any person (including household members of the subscriber) may recei'e or transmit 'ia the Internet3 or for anything bought or sold 'ia the Internet3 or for any other result of an action ta0en by anyone using its ser'ice

.lace: 8ate: !able 1 ,odem Charges (For Filling up 8etails as0ed at #& %9 > ( of Application form) Installation Charges 7s +44 (In case of ,odem from B#%&) ,odem Charges 1 Alternate to .urchase of ,odem (a) ,onthly 7ental 7s 144 (b) #ecurity 8eposit (%on 7efundable) 7s +44

#ignature of the applicant

#hifting Charges Change of .lan !able " .articulars Band width in ??? #ingle : ,ulti 6ser (#6 : ,6) ,onthly Charges 8iscounted Annual .ayment 9ption to Customers 8ownload :6p load &imit) Additional 6sage Charges : ,B Beyond free down load :upload limit (7s) Free e<mail id=s : #pace (.er e<mail id) #ecurity 8eposit

7s (44 7s 144 !ariff in 7s (For Filling up 8etails as0ed at #& %9 > ) of Application form) *ome .lan *ome +44 "+- @bps +44 +444 1 4 AB "4 1:+ ,B %il *ome 1444 (1) @bps 1444 14444 " AB 1 +4 *ome 1144 +1" @bps 1144 11444 + AB 1 +4 *ome ((44 1 ,bps ((44 ((444 14 AB 1 +4 Business .lan Business Business 1"44 (444 "+- @bps +1" @bps #6 ,6 1"44 (444 1"444 (4444 ) AB 14 AB " 44 1 +4 1: + ,B " ,onths rental " : + ,B " ,onths 7ental Business +444 1 ,bps ,6 +444 +4444 "4 AB 1 +4 " : + ,B " ,onths 7ental Business 2444 " ,bps ,6 2444 24444 )4 AB 1 +4 ) : + ,B " ,onths 7ental

1 : + ,B 1 : + ,B " : + ,B " ,onths " ,onths " ,onths 7ental 7ental 7ental ??? 6nder Ideal 6sage Conditions