Form No.

: BB / Static IP / Form-1

BHARAT SANCHAR NIGAM Ltd. PUNE SSA, MAHARASHTRA CIRCLE

APPLICATION FORM FOR STATIC IP OF BSNL BROAD BAND SERVICES CUSTOMERS DETAILS

1. Name of Customer : . 2. Name of Organization : . 3. Customer Postal Address : . 4. Contact Person (Name and address) : . 5. Contact Telephone No : . 6. Contact Mobile No : . 7. Fax no. : . 8. E-mail id (if any) : . 9. Broadband Telephone No. : . 10. Broadband User Id : . 11. Customer Broadband Plan : .

Undertaking for the static IP address on Broadband Tel. No. 1) We understand that this IP address can be renumbered at any point of time as per BSNLs requirements. 2) We understand that IP addresses assigned by BSNL are non portable and will have to be returned to BSNL at the time of termination / changing over to another provider / any other reason whereby my network is unusable. 3) We understand that I cannot in turn assign the IP addresses to other party. 4) We understand that IP addresses assigned by BSNL are subject to availability of IP addresses with BSNL. 5) We understand that IP addresses may be changed by BSNL at its discretion without assigning any reason and I have agreed for the same. 6) We understand that I may be required to pay for the IP addresses in the form of lease rental or other means, if such type of charge based regime is introduced at a later date and such payment may be required to be made retrospectively. Date Place Yours Faithfully

( Requirement for static ip -

1 Broadband plan (limited/unlimited with FIXED MONTHLY CHRGE Rs 1000/- & above but less than Rs 1500/-) ADDITIONAL CHARGE Rs 2000/- Annually . 2.Broadband plan (limited/unlimited) with FIXED MONTHLY CHRGE Rs 1500/- &Above but less than Rs 2799/-) ADDITIONAL CHARGE Rs 1800/- Annually .NO CHARGE FOR PLANS ABOVE Rs 2799. 2 undertaking as above on your letter head duly signed by director with stamp 3 Request letter for static ip on letter head with information of your telephone no. on which you need static ip, user id of broadband, new plan & exiting plan detail. 4 photo copy of telephone bill on which broadband is working 5. Send all this document to SDE NIB, 2nd flr., MHS Bhavan, BSNL,Pune -411001. 6. Fax no. 26361212. For any query about static IP tel. no. 26362333 / 26332333OR you can mail all documents to sdenibpn@dataone.in