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      BHARAT SANCHAR NIGAM LIMITED
         (A Government of India Enterprise)

     CHENNAI TELEPHONES

APPLICATION FORM FOR SHIFTING OF TELEPHONE
WITHIN THE SAME EXCHANGE AREA
Please read the instructions carefully before filling up the form
To: The Divisional Engineer Telephones (Internal)___________________Telephone Exchange
01 Telephone Number to be shifted  
Indicate whether it is (Tick whichever is applicable)
  SSI Category Telephone Direct Line Junction Local PCO STD PCO Temporary Line
             
02 Name of the subscriber  
03 Address where the
telephone is working
at present
 
04 New address          

For Installation

For Billing
[if different from Column(1)]

For Correspondence
[if different from Column(1)]
05 Date on which telephone is to be disconnected  
06 If the shifting is not immediately feasible, whether
the telephone connection should continue to work
 
07 The telephone number working in the same
building or adjacent building at new location
 
08 Existing Facilities (Tick whichever is available)  
STD ISD PRM CLIP Plug &
Socket
Plan
103
95 Access
> 50 Kms
Any other
please specify
               
09 Contact Telephone Number /
E-mail ID
 
I certify that I shall dynamically lock the STD/ISD facility before vacating the premises
Place:
Date:
Signature of subscriber/
Authorised Signatory
Status of Authorised Signatory