Application Form For BSNL Broadband Service

Company Name(s): 

(A Govt. of India Enterprises)
OFFICE OF………………………………………………………………...


Please fill the application form in capital letters only ( √ Tick wherever applicable)
1. Existing BSNL Telephone No. on which Broadband connection is required:
(Kindly enclose the copy of the latest bill paid)
2. Want to apply for a new connection: Yes □ No □
If Yes, than fill the separate form for new landline connection and attach the photo ID & other documents.
3. Educational Qualification (Optional): Doctorate/Post Graduate/Graduate/Matriculate/Other
4. Title/Name of the Customer / Firm /Organization (SURNAME FIRST)
5. Billing Address:
6. Address of Connection (i.e. Installation Address):
7. Contact Tel. No.: Resi. …………………….. Off.: ……………………. Mob.: …………………………
E-Mail Address: ………………………………..@.........................................................
8. Broadband Service being applied for Prepaid □ Postpaid □
9. Modem Options (See tariff details)
Do you want BSNL to Provide Modem : Yes □ No □
9. a. If Yes, then please tick any one of the following Options (i.e. A or B or C)
[ Type-I (Ethernet & One USB Port) ; Type-II (Ethernet & One Wi-Fi Port) ]
A) Option-1: Outright Modem Purchase from BSNL Type-I □ or Type-II □ (see conditions overleaf)
B) Option-2: Use BSNL Modem by paying Advance monthly Rental for Type-I □ or Type-II □
& Refundable Security Deposit of Rs. 500/- (Applicable for Postpaid Broadband service only)
C) Option-3: Free Modem (Please see condition for providing free modem in tariff details) □
(Applicable for Postpaid Broadband service only):
10. Type of Broadband connection (See conditions overleaf) : Business □ Residential □
(Applicable for Postpaid Broadband service only):
11. Choice of Tariff Plan : (See tariff details): (e.g. Combo749)
(Applicable for Postpaid Broadband service only)
12. Recharge Options for the Prepaid Customers (see tariff details)
Payment option (Applicable for Postpaid Broadband service only): Monthly □ Annually □
13. Choice of e-mail/user Ids: I II
(In case preferred Username is not available, BSNL will provide one Username Generated by the system)
14. Nominee (Optional):
15. Customer signature:
1. Application form is free of cost. The form may be filled up in capital letters only.
2. BSNL broadband services are available only for BSNL landline customers.
3. Subject to the acceptance of the application and technical feasibility BSNL will endeavor to provide the Broadband Service as
soon as possible.
4. The contract with BSNL for provision of Broadband Service will be for a minimum period from the date of commencement
(depending upon the plan chosen) in accordance with the tariff plan opted.
5. The data rates shown as down streams or upstream is applicable only to last mile. However BSNL does not hold
responsibility for lesser download or upload data rates caused by the accessed website status or the international gateway or
the media.
6. Customers are free to choose their own Modem of approved models.
7. All IP addresses assigned will be dynamic.
8. The Postpaid Broadband connection is likely to be withdrawn in case the customer surrenders BSNL telephone lines.
9. Shifting of Postpaid Broadband connection subject to the technical feasibility would be done on payment of the applicable
shifting charges.
10. Home users will be able to connect only one computer to the Modem. In case of business users, it would be possible to
connect more than one computer depending on the plan opted for.
11. Home user can get one email account upon request. User name as per the preference indicated by customer would be
allocated subject to their availability.
12. The subscriber is required to fully comply with the provisions of the Indian Telegraph Act 1885, Indian Telegraph Rules and
the Information Technology Act 2000 made there under and any amendments or replacements made there to from time to time.
13. For Prepaid Broadband Services:
(a) Creation of Pre-paid BB account will be free of any charges (other than Installation and Modem Charges) and the account
will be created with complementary balance of 50 MB with validity of 15 days from the date of creation.
(b) In case of Customer owned modem, only installation charges shall be applicable.
14. Conditions for providing Home plan or Business plan under Postpaid category:-
(a) Either Plan can be offered to subscribers having telephones in individual names working at homes/residences used for
personal purpose.
(b) Subscribers having telephones in the name of company, firms, shops, educational institutes or any other commercial entity
can be given only Business Plan. They are not eligible for Home Plan.
(c)Telephones working in individual names at commercial/business/office premises are also not entitled for Home Plans.
(d) Home plan can be given on bfones in the name of Government/company but actually working at residences of their
employees. An undertaking may be taken from the customer before providing the said connection.
15. (a) Payments for Postpaid: At the time of issue of Demand Note, following charges will be collected.
i) Installation charges (As applicable). Ii) Advance Rental as per billing cycle (One month / Two months). iii) Security
deposit of the modem (As Applicable). iv) Advance monthly rental for modem. v) Refundable security deposit for 2
months rental as per the plan (As applicable). vi) Service Tax, as applicable, will be levied.
(b) Payments for Prepaid: The following charges are payable at the time of application:
i) Modem charges (as Applicable) ii) Installation charges
16. Billing for the Postpaid Broadband service will be included in the normal b-fone bill. The billing cycle shall be same as b-fone
billing cycle etc. Monthly rental will be collected in advance and usage charges in arrears.
17. No migration is allowed to the lower tariff plan till the expiry of the committed period in case of Postpaid Broadband service.
1. BSNL reserves the right to disconnect the service to any customer in case there is sufficient evidence of the customer
intentionally or unintentionally using the service in a manner which would adversely impact BSNL or BSNL’s Network.
2. The customer shall be responsible for using the service only for Legal and appropriate purposes
3. BSNL reserves the right to terminate the services in the event of non-payment of bills preferred by BSNL in accordance
with the tariff plans opted by the customer and the extent of usage or any default on the part of customers.
1. BSNL will exercise all reasonable care in providing its services, but it is not responsible for interruption/service due to
power failures, equipment malfunctions, or acts of natural calamity.
2. BSNL is not responsible for subscriber’s computer hardware and software or areas of the Internet not under its control.
BSNL does not warrant privacy, security, or efficiency of the Internet.
3. BSNL is not responsible for actions taken by its customers or others as a result of its services.
4. BSNL is not responsible for material any person (including household members of the subscriber) may receive or transmit via
the Internet, or for anything bought or sold via the Internet, or for any other result of an action taken by anyone using its service.
5. Broadband connection will be provided subject to technical feasibility. BSNL will not be held responsible in case service is
denied on this ground.
6. BSNL will not be responsible for non-use of prepaid Broadband account if ADSL line is down or suspended for any reason. No
concession shall be admissible to the prepaid account.
Place: Signature of the subscriber
Date :