Nomination Form For Telephone Connection

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Nomination Form
[For Individual applicants Other than Joint Applicants ] I hereby nominate the person mentioned below who shall, in the event of my death, be entitled to get the telephone/ registration transferred through this form to his /her name or be entitled to be paid the amount of registration/security deposit for the telephone so registered in my name, to the exclusion of all other persons. (i) Name of the Nominee (In Block Letters) (ii) Relationship with applicant (ii) Full Address of the nominee (In Block Letters)

(iv) In case nominee is a minor, please indicate Date of Birth of minor

Signature of the Nominee:_______________ Name:________________________________ Full Address: __________________________ _________________________ Witness 1 Signature Name Complete Address

Signature of Applicant :_______________ Name :_____ Full Address:________________________ _

2. Signature Name Complete Address

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