Essay of Pco

BHARAT SANCHAR NIGAM LIMITED
(A Government of India Enterprise) (website : www.bsnl.co.in)

Office of GM TD________________________
Application cum Agreement Form for allotment of PCO
( Please read the instructions carefully before filling the form)

Affix self signed photograph

PART-A
(PLEASE USE CAPITAL LETTERS FOR FILLING UP THIS FORM)

1 A.

Name of the applicant
(SURNAME) (FIRST NAME) (MIDDLE NAME)

B. Sex: Male 2 Name of the institution / organisation 3 Name of Father / Husband of the applicant
(SURNAME)

Female
(if applicable)

(FIRST NAME)

(MIDDLE NAME)

4 Nationality 5 Date of Birth 7 Type of applicant : 8 Category of the applicant: Individual War Widow/Depandants Ex.Serviceman Defence Establishment 9 Type of access 10 Facilities required 11 PCO's proposed name 12 Number of PCO lines required 13(b) If yes, name of service provider 14 Do you wish to act as outlet for other BSNL services. If yes, the services you proposed to provide :
i iii v vii ix Sale of Excel/Cell One Cards Broadband connections including modem Sancharnet cards, ITC cards and other type of cash cards Information kiosks for various BSNL services & products Display/sale of various type of telephone instruments accessories. ii iv vi viii x Sale of all types of recharge coupons IPTV connections including set top box Bill collection of all post paid services through DD/cheque Booking of telegrams and delivery thereof Any other service for customer convenience Prepaid Basic (Fixed including WLL)

(dd/mm/yyyy)

6 Organisation Handicapped

Age

( completed years)

SC/ST Hospital Others GSM mobile (post paid)

Charitable Institution Para-Military Establishment Post paid basic (Fixed including Local, STD & ISD 13(a) Do you have an existing PCO No.(s) 13(c) Indicator No.

Local & STD

Yes

No

15 PAN/GIR No.
(In case PAN/GIR No. is not provided, declaration in Form 60/61, to be furnished)

16
Passport Electricity bill

E-Mail address (if any):...