BHARAT SANCHAR NIGAM LIMTED
BANGALORE TELECOM DISTRICT
APPLICATION FOR VIRTUAL PRIVATE NETWORK (VPN) SERVICE
(Please read the instructions before filling up the form)
The Commercial Officer (NS),
Bangalore Telecom District,
Amenity Block, Palace Road,
I/We, the undersigned hereby apply for virtual private network (VPN) service under the terms and
conditions detailed below:-
1. Name and Address of the Applicant (in block letters)
2. Billing address
3. Contact person and address for correspondence
4. Number of VPN extensions required: _______________
(Attach your private numbering plan with desired features in annexure)
5. Permanent Income Tax A/C No.:__________
6. Payment Details: Amount & Details of DD enclosed.
I/We hereby confirm that the extension numbers as mentioned in the annexure are part of our closed
user group and I/We undertake to pay all the bills pertaining to the VPN service provided to me/us as per the
tariff notified by BSNL.
I/We hereby declare that I/We will abide by the Indian Telegraph rules as amended from time to time.
Company Seal (Authorized Signatory)
Name of Applicant:
Details of group users, private numbering plan and features desired:
Sr. Name of group user Telephone Private off-net Off-net calling Authorization
No. number to be numbering plan access privilege Code
included in (PNP) number (Yes/No) (Local/STD/
Company seal (Authorized signatory)
1. Off-net access: This feature allows a VPN user to access his private network from any non VPN
location in the PSTN by using a personal identification number.
2. Off-net Calling: This feature allows the VPN user to call other numbers in the PSTN from any location
which have been defined to be in private network.
3. Private numbering plan: The subscriber can assign a numbering plan for his private network, this
numbering plan will have abbreviated numbers for each constituent locations of the private network.
The length of the abbreviated number is referred to as the numbering plan length.
Instructions for Filling up the Application Form
1. Individual must sign if the application is in individual’s name.
2. In case of proprietary concern, proprietor must sign himself and affix rubber stamp.
3. In case of partnership concern, all the partners or any of the partner duly authorized or manager with the
power of attorney may sign. In case of company, signature should be of a person on behalf of the
company, in accordance with the provisions of its Articles of Association.
4. In case of Govt. Department, authorized person may sign and affix rubber stamp.
5. Copy of documents duly attested may be attached as applicable.
a. Power of attorney in case of authorization.
b. Registered partnership deed or partnership deed with Form A issued by Registrar of Firms.
c. In case of SSI unit, permanent SSI certificate and personal liability certificate from the
proprietor of the unit.
d. In case of limited company, copy of the Articles of Association.
6. Status of Applicant (Please indicate one of the following)
i. Individual vii. PSU
ii. Partnership viii. Government
iii. Proprietorship ix. Statuary Body
iv. Limited Co. x. HUF
v. Public Institution xi. NRI
vi. Society/Association/Trust xii. Foreign National
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