CUSTOMER APPLICATION FORM

IPTV/VOD/MOD/KOD

Aksh
Please fill this form in CAPITAL LETTERS in black ink only

(A) MTNL Subscriber I !CA Number as "rinted in the bill#: MTNL Landline number on $hich %% is $orkin& ' IPT( is re)uired: *ther Landline numbers: (B) Subscriber Profile: Subscriber Name:

+ender:

Male

,emale

(C)

Installation Address:

(D) -our Contact Number 4 email:

5ome *ffice Mobile

Email:

(E) Select -our Packa&e: !-our Ser.ice $ill be acti.ated only after selectin& a Packa&e as addressed in ANNEXURE - 1)
Please note: Subscri"tion to one %asic Packa&e is com"ulsory/ Prices of the Packa&es are sub0ect to chan&e/ Packa&e Name/ 111111111111111111111111111111/ Please si&n this Subscri"tion Terms ' Conditions: This Subscri"tion Terms ' Conditions !$hich includes this Subscri"tion ,orm2 the Terms and Conditions and the 3ork *rder# is made bet$een MTNL and -ou2 the subscriber $hose name a""ears abo.e on this "a&e and $ho is bound to the Subscri"tion Terms ' Conditions by the si&nature2 $hich a""ears belo$: 3e $ill "ro.ide you $ith the ser.ice sub0ect to the conditions of this Subscri"tion Terms ' Conditions/

(F) I confirm that I ha.e read and understood all conditions set out and I a&ree to abide by them/
dd Si&nature 11111111111111111111111111 ate : mm yyyy

6This Subscri"tion terms ' conditions must be si&ned only by the subscriber or -our Authorised Re"resentati.e/7 Mac Address of ST%: !To be filled by MTNL 4 A8S5# Sr No:

PIN

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CUSTOMER APPLICATION FORM

IPTV/VOD/MOD/KOD

Aksh

Acknowledgement Slip Recei.ed bookin& for MTNL IPT( connection for Plan 11111111111111111111111111 on tele"hone No: 11111111111111111111111

ate: 11111111111111111111111111

!Si&natures of MTNL *fficial# 111111111111111111111111

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CUSTOMER APPLICATION FORM

IPTV/VOD/MOD/KOD

Aksh

(A) TERMS
9/ :/ ;/ </ =/ @/ A/ B/ D/ 9E/ 99/ 9:/ 9;/ 9</ 9=/ 9@/ 9A/ 9B/ 9D/ :E/ :9/

C!ND"T"!NS# -

::/ :;/

:</ :=/

%ookin& $ill be confirmed sub0ect to feasibility/ The a""licant shall "ay the re&istration fee de"osit $hich $ill be char&ed in tele"hone bill/ MTNL shall ha.e the sole discretion to acce"t or re0ect the a""lication $ithout assi&nin& any reason/ In case the a""lication is re0ected2 the de"osit shall be refunded to the a""licant/ The ST% and the accessories shall be solely used for a.ailin& IPT( ser.ices on Triband of MTNL and shall not be used for a.ailin& ser.ices of any other Net$ork/ The Set To" %o> and the accessories shall be used for .ie$in& authori?ed channels2 "ro&rams and ser.ices/ The subscriber shall take ade)uate care of the ST%2 durin& the "eriod of the a&reement/ Any $illful default or dama&e to ST% $ill be in the account of the subscriber/ The subscriber shall not $ithout the "rior authori?ation of MTNL2 remo.e2 transfer or other$ise relocate the ST% from the ori&inal "lace of installation2 failin& $hich the de"osit shall be forfeited ' MTNL shall be entitled to reco.er the cost of the bo> and 4 or initiate le&al action In case ST% is lost or dama&ed on account of theft2 bur&lary or by any other accidentC the subscriber shall file a "olice com"laint forth$ith and notify MTNL of such loss immediatelyC failin& $hich MTNL reser.es the ri&ht to reco.er the cost of the ST% from the subscriber/ In case of non"ayment 4 delay in "ayment of rentals/ MTNL shall reser.e the ri&ht to cancel 4 sus"end the ser.ice and to discontinue the Ser.ices/ In such cases2 the subscriber shall return the ST% in &ood $orkin& conditionC failin& $hich the de"osit shall be ad0usted to$ards the cost of ST%/ The Pay Channel feesC as "rescribed from time to time for each channel selected shall be "aid/ The subscriber shall2 in ad.ance notify chan&e of address 4 contact number to MTNL or its authori?ed re"resentati.e for future corres"ondence 4 conte>t/ In case the subscriber desires to discontinue the ser.ices2 he shall return the ST% in &ood $orkin& condition/ ,or reconnection 4 acti.ation of the ser.ice earlier disconnected for any reason2 the subscriber shall "ay reconnection char&es as "rescribed from time to time/ IPT( ser.ices in res"ect of Pay Channels shall be a.ailable to the subscriber sub0ect to ,orce Ma0eure conditions includin& but not limited to act of +od2 fires2 strikes2 embar&oes2 $ar insurrection2 riots and other causes beyond the reasonable control of MTNL includin& atmos"heric 4 to"o&ra"hical hindrances/ Subscriber4s are not authori?ed to install any +ad&ets on ST% $ithout MTNLFs "rior $ritten "ermission/ The subscriber has to "rotect the ST%/ Subscriber shall not be entitled to transfer or assi&n its obli&ations and liabilities under the terms and conditions to any other "arty under any circumstances $ithout "rior "ermission of MTNL/ Any transfer affected in contra.ention of the e>"ressed terms contained herein shall not absol.e the Subscriber of its obli&ations 4liability to$ards MTNL/ All ta>es2 le.ies etc/ "resent and future shall be to the account of subscriber as a""licable/ The tariff 4 char&es for Pay Channels are based on A&reements $ith Pay Channels at the time of "resentation of this form/ In case of any chan&e in these arran&ements2 additional a""licable char&es2 shall be "ayable by the Subscriber/ The Subscriber shall make "ayment to MTNL a&ainst the bill raised by MTNL on or before the due date/ IPT( Ser.ice )uality2 functionality2 a.ailability and 4 or reliability may be affected and 4 or MTNL is entitled to2 $ithout any liability2 refuse2 limit2 sus"end2 .ary2 disconnect and or interru"t the Ser.icesC in $hole or in "art2 at any time in its sole discretion $ith res"ect to one 4 all Subscribers2 $ithout any notice or reasons/ In case of misuse of Ser.ices or breach of any terms and conditions by the subscriber or use of ser.ices by the subscriber in such a manner that it .iolates any la$s or ad.ersely affects or interferes $ith MTNL Ser.ice2 Com"any shall &i.e notice of fi.e !=# days to the Subscriber to remedy the breach/ In case the Subscriber fails to remedy the said breach $ithin the notice "eriod2 MTNL shall be entitled to discontinue the Ser.ices forth$ith/ MTNL at its sole discretion may sus"end4 discontinue the Ser.ices by &i.in& reasonable notice to Subscriber/ The IPT( ser.ice is liable for disconnection "artially or other$ise due to: a/ Chan&es in the la$2 rules2 re&ulations or orders2 directions2 notifications etc by the Authorities/ b/ Physical obstruction2 &eo&ra"hic2 to"o&ra"hic2 hydrolo&ical2 meteorolo&ical and other causes of cable interference or faults in other net$orks of Pay Channels to $hich the Net$ork is connected/ c/ Any discre"ancies 4 $ron& "articulars "ro.ided by the Subscriber/ Any dis"ute or difference of any nature $hatsoe.er or re&ardin& any ri&ht2 liability2 act2 omission on account of any of the "arties hereto arisin& out of or in relation to this terms ' conditions shall be settled by arbitration in accordance to MTNL/ 5o$e.er subscriber has ri&ht to a""eal to the ne>t hi&her authority/ The .alidity2 construction and "erformances of terms and conditions herein shall be &o.erned by and inter"reted in accordance $ith "re.ailin& la$s/ MTNL and Subscriber a&ree to submit to the e>clusi.e 0urisdiction of the elhi Courts/

:@/ I hereby undertake that I $ill fully abide by Indian co"yri&ht Act 9DD< and as amended from time to time/ I $ill not indul&e in "ilfera&e4 co"y of the content etc as "rohibited by the la$/ In the e.ent of any such .iolation2 ci.il or criminal action may instituted for in0unction2 actual dama&es !includin& infrin&erGs "rofit# etc/ :A/ A.ailability of audioHin and (ideoHin "orts in T( $ill be the sole res"onsibility of the subscriber!audioHin and (ideoHin "orts are re)uired for interfacin& the ST%#/
:B/ The customer is re)uired to fully com"ly $ith the "ro.isions of the Indian Tele&ra"h Act2 9BB= and Information Technolo&y !IT# Act2 :EEE ' the Indian Tele&ra"h Rules made there under and any amendments or re"lacements made there to from time to time/
I 43e ha.e read and understood the terms and Conditions "ro.ided o.erleaf and ackno$led&e that the tariff "lan selected and I a&ree to be bound by the same/ I 43e a&ree to abide by the "ro.isions of MTNL and the rules made there under and as also such amendments as may be made from time to time to these rules in so far as they relate to the Ser.ices/ I4 3e hereby declare and confirm that the abo.e information "ro.ided by me 4 us is 4 are totally correct and true in e.ery res"ect/

Place: 1111111111111111111

Si&nature of Subscriber : 111111111111111111111111111 3 of 4

CUSTOMER APPLICATION FORM

IPTV/VOD/MOD/KOD

Aksh
Abbre.iations: IPT( I Internet Protocol T( 4 (* I (ideo *n emand 4 TST( I Time Shift T(

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