Professional Documents
Culture Documents
To be Filled by SUBSCRIBER
Internet service provider: __________________________________________ Bandwidth (in kbps/ mbps/ others specify):__________
Type of connection (DSL/ LAN/ WAN/ Dial-up/ Vsat/ cable/ in case of others please specify):________________________________
In case of static IP alloted to the connection
1. IP address: ________________________ 2. Sub-net mask: _____________________ 3. Gateway: _____________________
4. DNS1: _____________________ 5. DNS2: _____________________ 6. DNS3(optional): _____________________ .
All Payments to be made in favour of M/s. Suryansh Trans Services Pvt. Ltd., Hyderabad, INDIA
Mode of Payment (Cheque/ e-Cheque/ Wire Transfer/ Payment Gateway/ Credit Card/ Debit Card/ Others please specify :
____________________________________________________________________________________________________________
Instrument Number: __________________________________ Transaction ID : _____________________________________
Facilitator ( Name of Bank/ Card issuer/ Site URL/ etc.) : _____________________________________________________________
Please furnish proof of identity/ address by furnishing self-attested true copy of documents mentioned below
Declaration To be Filled by dealer/ franchise
I/We have read & understood the terms & conditions mentioned I/ We hereby undertake & confirm that I /We have duly verified
overleaf & unconditionally accept them as binding on me/ us. I/ a ll the signatures, details & documents given by the
we have understood all the rates & tariffs & other related aforementioned subscriber in this enrollment form with their
conditions at which IP telephony services will provided as respective originals.
applicable on this date & as amended from time to time. I/we Category: Urban/ Rural Remarks:____________________
hereby undertake to pay all charges raised on account of services
_____________________________________________________
being availed/ availed. I/we further declare & undertake that the
above information provided by me/ us is true & correct in all
respect. I the signatory is more than 21 years old, mentally sound Name & signature of the dealer/ franchisee/ sub franchisee
and qualified to execute and enter into a contract as per the laws _____________________________________________________
of my country of domicile at the time of this application.
Date: _____________ Time: _______ Sign: ________________
Date: ______________Time: __________ Sign______________
__________________________________________________
Signature of Subscriber// authorised signatory