NEPAL TELECOM

passport size
photograph with
Customer
authorised
signature

(Nepal Doorsanchar Company Limited)

APPLICATION FORM
Broadband Wireless Service ( [ ] WiMAX [ ] Wifi )
1.

Customers Name (in BLOCK LETTERS):

2.

Customers Permanent Address:

Ward No

Zone

District

Installation Address:
Ward No
House No

Street Name

Zone

District

3.

House No

Street Name

4.

Customers Mobile:

5.

Customers Identity:

Citizenship

Number:

Passport

Tole Name

VDC/Municipality

Tole Name

VDC/Municipality

Email:
PAN

specify

Others

District:

6.

Name of Company/Firm/Organization:

7.

Company/Firm/Organizations Full Address:

8.

Customers ID:

9.

Type of CPE required:

Outdoor

Indoor

USB Dongle

10.

Data Rate (Speed):

256 Kbps

512 Kbps

1Mbps or above

11.

Volume in GB:

12.

Validity:

Site Map of the users premises from the Main Road ....

Finger Prints

Distance of residence is ........ meters from nearest Main Road.

right

left

.......................................
Customer Signature
Date : 20 /
/

FOR OFFICE USE ONLY

A Application Received Date

B CPE Make

Receipt No
Model

C MAC CPE
D Date of activation
................................................
Signature
Name
Designation

E Vendor

g]kfn 6]lnsd / >L ===================================================================aLr ;DkGg ePsf]

;Demf}tf

g]kfn 6]lnsd - h;nfO{ o;kl5 sDkgL egL ;Daf]wg ul/Psf] 5 _ / >L ========================================== sf] gftLgftLgL, >L =========================== sf] 5f]/
f5f]/L >LdtL, =========================== lhNnf ================== dxfgu/kflnsf pkdxfgu/kflnsf/ gu/kflnsf uf=la=;=,a8f g+ ===== a:g] g]kfn 6]lnsd4f/f
ljtl/t WiMAX Outdoor / Indoor/ USB Dongle sf] df]8]n g+ ==================================== sf u|fxs aif{ ======= sf] >L ============================= gf=k|=g+=
=================== gf=k|=g+ ljt/0f ePsf] lhNNff =========================== - h;nfO{ o;kl5 u|fxs egL ;Daf]wg ul/Psf] 5 _ aLr ;]jf pkef]u ug]{u/fpg] p2Zon] lgDg pNn]
lvt zt{x? kfngf ug{ b'a} kIf ;xdt e} b:tvt ;lx5fk u/L PsPs k|lt a'lem lnof}+,lbof}+ .



zt{x? M
!= ;]jf pkef]usf] nflu sDkgL4f/f ljls| ul/g] WiMAX CPE (Outdoor/Indoor/USB Dongle) sf] d"No, Activation charge, ;+rfng dxz"n b/ tyf g]kfn
;/sf/n] tf]s] adf]lhdsf] s/ /sd u|fxsn] sDkgLdf a'emfpg' kg]{5 .
@= u|fxsnfO{ sDkgL4f/f ljls| u/]sf] ;]6df ljls| u/]sf] ldltn] # dlxgfsf] cjlwleq ;]6sf] pTkfbg v/fljsf] sf/0fn] u|fxssf] c;fjwfgLn] ubf{ pQm ;]6 6'6km'6 ePdf
jf x/fPsf] cj:yfdf sDkgLn] lgwf{/0f u/]sf] d'No u|fxsaf6 c;'n u/L gofF WiMAX CPE pknAw u/fOg]5 .
#= pQm cjlw kZrft WiMAX CPE h'g;'s} k|sf/sf] v/flj cfPdf klg sDkgLn] lgwf{/0f u/]sf] WiMAX CPE sf] d'No u|fxsaf6 c;'n u/L gofF WiMAX CPE
pknAw u/fOg] 5 .
$= u|fxsn] sDklgn] tf]s]sf] cflwsfl/s ljs|]tf dfkm{t WiMAX CPE vl/b u/]df, u|fxs / las|]tf ljrsf] zt{x? nfu' x'g]5 .
%= sDkgLaf6 WiMAX Outdoor CPE lnPsf u|fxsx?n] h'g 7]ufgfdf lnPsf] xf] ;f]lx 7]ufgfdf dfq pQm ;]jf ;+rfng ug'{ kg]{5 .
^= WiMAX CPE x/fPdf cljnDj ;DalGwt sfo{nodf lnlvt ;"rgf lbP/ aGb u/fpg' kg]{5 . ;]jf k'g ;+rfngsf] nflu glhssf] sfo{no jf u|fxs ;]jf s]Gb|df
;Dks{ ug'{ kg]{5.
&= pkef]u u/]sf] ;]jf cj?4 ePdf u|fxsn] sDkgLsf] tf]lsPsf] :yfgdf ;"rgf ug'{ kg]{5 . ;"rgf k|fKt kZrft\ Fault kQfnufO{ cj?4 ;]jf cljnDa ;"rf? ul/g]5 .
*= s'g} klg u|fxsn] lnPsf] ;]jf, ;'ljwf hf]];'s}n] k|of]u u/]sf] ePtf klg ;f] sf] lhDd]jf/L h;sf] gfddf btf{ ePsf] 5 ;f]xL u|fxsn] g} axg ug'{ kg]{5 .
( ;]jf;+u ;DjlGwt cGo yk ;'ljwfx? Tff]lsP adf]lhdsf] /sd a'emfO{ u|fxsn] dfu u/]sf] v08df Ifdtfn] EofP;Dd sDkgL4f/f pknAw u/fOg]5 .

!)= ;]jf;+u ;DalGwt sDkgLn] ljBdfg gLlt, lgod, ljlgod eljiodf x'g] kl/jt{g tyf eljiodf aGg] gofF gLlt, lgod, ljlgod ;DjlGwt lgsfosf] :jLs[lt k|fKt
ePkl5 ;fj{hlgs ;"rgf k|sflzt u/] kZrft pQm gLlt, lgod, ljlgodx? b'a} kIfnfO{ dfGo x'g] 5 To;nfO{ of] ;Demf}tfsf] cleGg cu+ dflgg] 5 .
!!= o; ;Demf}tfdf pNn]lvt zt{x? kl/jt{g tyf yk ug'{ k/]df g]kfn b"/;+rf/ k|flws/0fsf] :jLs[tL kZrft ;fj{hlgs ;"rgfaf6 yk jf kl/jt{g ug{ ;Sg]5 . o;/L
;"rgfaf6 yk ePsf zt{x? o; ;Demf}tfsf] cleGg cu+ dflgg] 5 t/ zt{ kl/jt{g ubf{ !% lbg cufj} u|fxsju{x?nfO{ ;"lrt ul/g] 5 . Psk6s h8fgul/ ;+rfngdf
cfPsf] pks/0f tyf ;]jflkmtf{ ul/g] 5}g .
!@= cfkm\gf] afx]s c?sf] gfddf ;]jf lng k/]df cfkm\gf] kl/rokq / kmf]6f] ;]dt clgjfo{ k]z ug{ kg]{5 .