PROFORMA FOR PHYSIC

1 I............................................................................, aged about ..............year s\o, d\o Shri

resident of .............................................................................................................. do solem
2 That I am .........................................................................of Bharat sanchar Nigam Limited (
dated ............................. passed by Board of Directors of the Company to furnish a Certifica
3 That as per the agreement signed with Administrator, USOF vide Agreement No. ________
for Provisioning of mobile services in the areas
affected by Left Wing Extremism (LWE) , the following works have been completed succe
condition of the Agreement :A.
BTS
(i)
(ii)
(iII)
(vi)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
(xi)
(xii)
B.
Battery:
(i)
(ii)
(iII)
(vi)
(v)
(vi)
C.
SMPS Power Plant:
(i)
(ii)
(iII)
(vi)
(v)
(vi)
C.
Solar Power System
(i)
(ii)
(iII)
(vi)
(v)
D.
Antenna for BTS / Microwave (To be provided separately):
(i)
(ii)
(iII)

E.

F.
G.

(vi)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
Backhaul:
(i)
(ii)

Electrical Power Supply:

(i)
Signal Coverage Details:
The actual coverage achieved from the infrastructure site installed is as given b
Type of
Coverage
Indoor
Coverage
Outdoor
Coverage

4 Acceptance Testing of all equipments and infrastructure has been completed by BSNL as p
mentioned above are
5 available for further verification by the appropriate authorities and that the component hav
6 That the components at the infrastructure site shown as installed/ commissioned in the said
7 The date of commissioning of mobile services is____________________________.
8 The contents of the Proforma are true and correct based on the records of the company , n
For on behalf of BSNL

Signature of authorized signatory of BSNL

PROFORMA FOR PHYSICAL / TECHNICAL DETAIL

......................................................., aged about ..............year s\o, d\o Shri

........................................................................................................... do solemnly affirm and state as under:
....................................................................of Bharat sanchar Nigam Limited (BSNL), and I am duly authorized by
................ passed by Board of Directors of the Company to furnish a Certificate on behalf of BSNL.
e agreement signed with Administrator, USOF vide Agreement No. ____________________ Dated__________
g of mobile services in the areas
eft Wing Extremism (LWE) , the following works have been completed successfully as per the specifications in th
he Agreement :Name of the Location:
Name of the district & State:
Location of the Tower (Lat., Long) :
Height of the Tower (in metres)
Make:
Model:
Date of the manufacturing:
Serial No:
Configuration (Sectors and TRX in each sector)
Radiated power:
SACFA Clearance status:
Date of commissioning:

Rated Capacity:
Make:
Type:
Date/ Year of Manufacturing:
Number of Sets
Date of Commissioning:
MPS Power Plant:
Rated Capacity of each Module:
Make:
Type:
Date/ Year of Manufacturing:
Number of Modules
Date of Commissioning:
olar Power System
Capacity
Make:
Type:
Date/ Year of Manufacturing:
Date of Commissioning:
ntenna for BTS / Microwave (To be provided separately):
Type:
Gain:
Beam Width:

Size
Weight
Frequency of operation:
Location on the Tower
Make
Date/ Year of Manufacturing:
Date of Commissioning:
Type of backhaul;
Antenna Specification as per (D) above in case of microwave

ectrical Power Supply:

Wattage Capacity
gnal Coverage Details:
he actual coverage achieved from the infrastructure site installed is as given below:

Coverage Achieved

esting of all equipments and infrastructure has been completed by BSNL as per its extant provisions.
urther verification by the appropriate authorities and that the component have been provided and are functiona
ponents at the infrastructure site shown as installed/ commissioned in the said quarter have been completed on th
mmissioning of mobile services is____________________________.
of the Proforma are true and correct based on the records of the company , no part of it false and nothing has bee

signatory of BSNL

R PHYSICAL / TECHNICAL DETAILS

\o, d\o Shri ..

...... do solemnly affirm and state as under:
gam Limited (BSNL), and I am duly authorized by the resolutions
nish a Certificate on behalf of BSNL.
No. ____________________ Dated__________

mpleted successfully as per the specifications in the terms and

Bande-2 (Bande Colony)

Kanker, Chhattisgarh
195529818032'36.40N 0000'00.00E
40
Alcatel
A9100
NT1019M0010
6/6/2006
43 dBm (20W)
Applied
18.03.2011
200Ah
Exide
VRLA
1
March, 2015
25 A
Delta
1 phase
4
March, 2011

OFC
NA

3 phase/ 12 kW

d is as given below:

by BSNL as per its extant provisions.

mponent have been provided and are functional/services are being rendered from the date on which they ha
ned in the said quarter have been completed on the dates as shown above.

e company , no part of it false and nothing has been concealed from.

PROFORMA FOR PHYSIC

1 I............................................................................, aged about ..............year s\o, d\o Shri

resident of .............................................................................................................. do solem
2 That I am .........................................................................of Bharat sanchar Nigam Limited (
dated ............................. passed by Board of Directors of the Company to furnish a Certifica
3 That as per the agreement signed with Administrator, USOF vide Agreement No. ________
for Provisioning of mobile services in the areas
affected by Left Wing Extremism (LWE) , the following works have been completed succe
condition of the Agreement :A.
BTS
(i)
(ii)
(iII)
(vi)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
(xi)
(xii)
B.
Battery:
(i)
(ii)
(iII)
(vi)
(v)
(vi)
C.
SMPS Power Plant:
(i)
(ii)
(iII)
(vi)
(v)
(vi)
C.
Solar Power System
(i)
(ii)
(iII)
(vi)
(v)
D.
Antenna for BTS / Microwave (To be provided separately):
(i)
(ii)
(iII)

E.

F.
G.

(vi)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
Backhaul:
(i)
(ii)

Electrical Power Supply:

(i)
Signal Coverage Details:
The actual coverage achieved from the infrastructure site installed is as given b
Type of
Coverage
Indoor
Coverage
Outdoor
Coverage

4 Acceptance Testing of all equipments and infrastructure has been completed by BSNL as p
mentioned above are
5 available for further verification by the appropriate authorities and that the component hav
6 That the components at the infrastructure site shown as installed/ commissioned in the said
7 The date of commissioning of mobile services is____________________________.
8 The contents of the Proforma are true and correct based on the records of the company , n
For on behalf of BSNL

Signature of authorized signatory of BSNL

PROFORMA FOR PHYSICAL / TECHNICAL DETAIL

......................................................., aged about ..............year s\o, d\o Shri

........................................................................................................... do solemnly affirm and state as under:
....................................................................of Bharat sanchar Nigam Limited (BSNL), and I am duly authorized by
................ passed by Board of Directors of the Company to furnish a Certificate on behalf of BSNL.
e agreement signed with Administrator, USOF vide Agreement No. ____________________ Dated__________
g of mobile services in the areas
eft Wing Extremism (LWE) , the following works have been completed successfully as per the specifications in th
he Agreement :Name of the Location:
Name of the district & State:
Location of the Tower (Lat., Long) :
Height of the Tower (in metres)
Make:
Model:
Date of the manufacturing:
Serial No:
Configuration (Sectors and TRX in each sector)
Radiated power:
SACFA Clearance status:
Date of commissioning:

Rated Capacity:
Make:
Type:
Date/ Year of Manufacturing:
Number of Sets
Date of Commissioning:
MPS Power Plant:
Rated Capacity of each Module:
Make:
Type:
Date/ Year of Manufacturing:
Number of Modules
Date of Commissioning:
olar Power System
Capacity
Make:
Type:
Date/ Year of Manufacturing:
Date of Commissioning:
ntenna for BTS / Microwave (To be provided separately):
Type:
Gain:
Beam Width:

Size
Weight
Frequency of operation:
Location on the Tower
Make
Date/ Year of Manufacturing:
Date of Commissioning:
Type of backhaul;
Antenna Specification as per (D) above in case of microwave

ectrical Power Supply:

Wattage Capacity
gnal Coverage Details:
he actual coverage achieved from the infrastructure site installed is as given below:

Coverage Achieved

esting of all equipments and infrastructure has been completed by BSNL as per its extant provisions.
urther verification by the appropriate authorities and that the component have been provided and are functiona
ponents at the infrastructure site shown as installed/ commissioned in the said quarter have been completed on th
mmissioning of mobile services is____________________________.
of the Proforma are true and correct based on the records of the company , no part of it false and nothing has bee

signatory of BSNL

R PHYSICAL / TECHNICAL DETAILS

\o, d\o Shri ..

...... do solemnly affirm and state as under:
gam Limited (BSNL), and I am duly authorized by the resolutions
nish a Certificate on behalf of BSNL.
No. ____________________ Dated__________

mpleted successfully as per the specifications in the terms and

Newmarket, Pakhanjore
Kanker, Chhattisgarh
200141368037'47.20N 0000'00.00E
40
Alcatel
A9100
NT0713M0189
4/4/2004
43 dBm (20W)
Applied
Dec, 2011
200Ah
Exide
VRLA
1
March, 2015
100A
Adore
3 phase
1
Dec, 2011

Minilink
NA

3 phase/ 16kW

d is as given below:

by BSNL as per its extant provisions.

mponent have been provided and are functional/services are being rendered from the date on which they ha
ned in the said quarter have been completed on the dates as shown above.

e company , no part of it false and nothing has been concealed from.

PROFORMA FOR PHYSIC

1 I............................................................................, aged about ..............year s\o, d\o Shri

resident of .............................................................................................................. do solem
2 That I am .........................................................................of Bharat sanchar Nigam Limited (
dated ............................. passed by Board of Directors of the Company to furnish a Certifica
3 That as per the agreement signed with Administrator, USOF vide Agreement No. ________
for Provisioning of mobile services in the areas
affected by Left Wing Extremism (LWE) , the following works have been completed succe
condition of the Agreement :A.
BTS
(i)
(ii)
(iII)
(vi)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
(xi)
(xii)
B.
Battery:
(i)
(ii)
(iII)
(vi)
(v)
(vi)
C.
SMPS Power Plant:
(i)
(ii)
(iII)
(vi)
(v)
(vi)
C.
Solar Power System
(i)
(ii)
(iII)
(vi)
(v)
D.
Antenna for BTS / Microwave (To be provided separately):
(i)
(ii)
(iII)

E.

F.
G.

(vi)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
Backhaul:
(i)
(ii)

Electrical Power Supply:

(i)
Signal Coverage Details:
The actual coverage achieved from the infrastructure site installed is as given b
Type of
Coverage
Indoor
Coverage
Outdoor
Coverage

4 Acceptance Testing of all equipments and infrastructure has been completed by BSNL as p
mentioned above are
5 available for further verification by the appropriate authorities and that the component hav
6 That the components at the infrastructure site shown as installed/ commissioned in the said
7 The date of commissioning of mobile services is____________________________.
8 The contents of the Proforma are true and correct based on the records of the company , n
For on behalf of BSNL

Signature of authorized signatory of BSNL

PROFORMA FOR PHYSICAL / TECHNICAL DETAIL

......................................................., aged about ..............year s\o, d\o Shri

........................................................................................................... do solemnly affirm and state as under:
....................................................................of Bharat sanchar Nigam Limited (BSNL), and I am duly authorized by
................ passed by Board of Directors of the Company to furnish a Certificate on behalf of BSNL.
e agreement signed with Administrator, USOF vide Agreement No. ____________________ Dated__________
g of mobile services in the areas
eft Wing Extremism (LWE) , the following works have been completed successfully as per the specifications in th
he Agreement :Name of the Location:
Name of the district & State:
Location of the Tower (Lat., Long) :
Height of the Tower (in metres)
Make:
Model:
Date of the manufacturing:
Serial No:
Configuration (Sectors and TRX in each sector)
Radiated power:
SACFA Clearance status:
Date of commissioning:

Rated Capacity:
Make:
Type:
Date/ Year of Manufacturing:
Number of Sets
Date of Commissioning:
MPS Power Plant:
Rated Capacity of each Module:
Make:
Type:
Date/ Year of Manufacturing:
Number of Modules
Date of Commissioning:
olar Power System
Capacity
Make:
Type:
Date/ Year of Manufacturing:
Date of Commissioning:
ntenna for BTS / Microwave (To be provided separately):
Type:
Gain:
Beam Width:

Size
Weight
Frequency of operation:
Location on the Tower
Make
Date/ Year of Manufacturing:
Date of Commissioning:
Type of backhaul;
Antenna Specification as per (D) above in case of microwave

ectrical Power Supply:

Wattage Capacity
gnal Coverage Details:
he actual coverage achieved from the infrastructure site installed is as given below:

Coverage Achieved

esting of all equipments and infrastructure has been completed by BSNL as per its extant provisions.
urther verification by the appropriate authorities and that the component have been provided and are functiona
ponents at the infrastructure site shown as installed/ commissioned in the said quarter have been completed on th
mmissioning of mobile services is____________________________.
of the Proforma are true and correct based on the records of the company , no part of it false and nothing has bee

signatory of BSNL

R PHYSICAL / TECHNICAL DETAILS

\o, d\o Shri ..

...... do solemnly affirm and state as under:
gam Limited (BSNL), and I am duly authorized by the resolutions
nish a Certificate on behalf of BSNL.
No. ____________________ Dated__________

mpleted successfully as per the specifications in the terms and

Awaspara, Pakhanjur
Kanker, Chhattisgarh
200219228037'03.00N 0000'00.00E
40
Alcatel
A9100
NT0952R2449
4/4/2004
43 dBm (20W)
Applied
06.03.2011
200Ah
Exide
VRLA
1
March, 2015
100A
Himachal Exicom
3 phase
1
March, 2011

Minilink
NA

3 phase/ 12 kW

d is as given below:

by BSNL as per its extant provisions.

mponent have been provided and are functional/services are being rendered from the date on which they ha
ned in the said quarter have been completed on the dates as shown above.

e company , no part of it false and nothing has been concealed from.

PROFORMA FOR PHYSIC

1 I............................................................................, aged about ..............year s\o, d\o Shri

resident of .............................................................................................................. do solem
2 That I am .........................................................................of Bharat sanchar Nigam Limited (
dated ............................. passed by Board of Directors of the Company to furnish a Certifica
3 That as per the agreement signed with Administrator, USOF vide Agreement No. ________
for Provisioning of mobile services in the areas
affected by Left Wing Extremism (LWE) , the following works have been completed succe
condition of the Agreement :A.
BTS
(i)
(ii)
(iII)
(vi)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
(xi)
(xii)
B.
Battery:
(i)
(ii)
(iII)
(vi)
(v)
(vi)
C.
SMPS Power Plant:
(i)
(ii)
(iII)
(vi)
(v)
(vi)
C.
Solar Power System
(i)
(ii)
(iII)
(vi)
(v)
D.
Antenna for BTS / Microwave (To be provided separately):
(i)
(ii)
(iII)

E.

F.
G.

(vi)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
Backhaul:
(i)
(ii)

Electrical Power Supply:

(i)
Signal Coverage Details:
The actual coverage achieved from the infrastructure site installed is as given b
Type of
Coverage
Indoor
Coverage
Outdoor
Coverage

4 Acceptance Testing of all equipments and infrastructure has been completed by BSNL as p
mentioned above are
5 available for further verification by the appropriate authorities and that the component hav
6 That the components at the infrastructure site shown as installed/ commissioned in the said
7 The date of commissioning of mobile services is____________________________.
8 The contents of the Proforma are true and correct based on the records of the company , n
For on behalf of BSNL

Signature of authorized signatory of BSNL

PROFORMA FOR PHYSICAL / TECHNICAL DETAIL

......................................................., aged about ..............year s\o, d\o Shri

........................................................................................................... do solemnly affirm and state as under:
....................................................................of Bharat sanchar Nigam Limited (BSNL), and I am duly authorized by
................ passed by Board of Directors of the Company to furnish a Certificate on behalf of BSNL.
e agreement signed with Administrator, USOF vide Agreement No. ____________________ Dated__________
g of mobile services in the areas
eft Wing Extremism (LWE) , the following works have been completed successfully as per the specifications in th
he Agreement :Name of the Location:
Name of the district & State:
Location of the Tower (Lat., Long) :
Height of the Tower (in metres)
Make:
Model:
Date of the manufacturing:
Serial No:
Configuration (Sectors and TRX in each sector)
Radiated power:
SACFA Clearance status:
Date of commissioning:

Rated Capacity:
Make:
Type:
Date/ Year of Manufacturing:
Number of Sets
Date of Commissioning:
MPS Power Plant:
Rated Capacity of each Module:
Make:
Type:
Date/ Year of Manufacturing:
Number of Modules
Date of Commissioning:
olar Power System
Capacity
Make:
Type:
Date/ Year of Manufacturing:
Date of Commissioning:
ntenna for BTS / Microwave (To be provided separately):
Type:
Gain:
Beam Width:

Size
Weight
Frequency of operation:
Location on the Tower
Make
Date/ Year of Manufacturing:
Date of Commissioning:
Type of backhaul;
Antenna Specification as per (D) above in case of microwave

ectrical Power Supply:

Wattage Capacity
gnal Coverage Details:
he actual coverage achieved from the infrastructure site installed is as given below:

Coverage Achieved

esting of all equipments and infrastructure has been completed by BSNL as per its extant provisions.
urther verification by the appropriate authorities and that the component have been provided and are functiona
ponents at the infrastructure site shown as installed/ commissioned in the said quarter have been completed on th
mmissioning of mobile services is____________________________.
of the Proforma are true and correct based on the records of the company , no part of it false and nothing has bee

signatory of BSNL

R PHYSICAL / TECHNICAL DETAILS

\o, d\o Shri ..

...... do solemnly affirm and state as under:
gam Limited (BSNL), and I am duly authorized by the resolutions
nish a Certificate on behalf of BSNL.
No. ____________________ Dated__________

mpleted successfully as per the specifications in the terms and

Kapsi-2 (Bade Kapsi)

Kanker, Chhattisgarh
200515738046'51.30N 0000'00.00E
40
Alcatel
A9100
NT1018M0008
6/6/2006
43 dBm (20kW)
Applied
07.03.2011
200Ah
Exide
VRLA
1
March, 2015
25 A
Delta
1 phase
6
March, 2011

Minilink
NA

3 phase/ 12 kW

d is as given below:

by BSNL as per its extant provisions.

mponent have been provided and are functional/services are being rendered from the date on which they ha
ned in the said quarter have been completed on the dates as shown above.

e company , no part of it false and nothing has been concealed from.

PROFORMA FOR PHYSIC

1 I............................................................................, aged about ..............year s\o, d\o Shri

resident of .............................................................................................................. do solem
2 That I am .........................................................................of Bharat sanchar Nigam Limited (
dated ............................. passed by Board of Directors of the Company to furnish a Certifica
3 That as per the agreement signed with Administrator, USOF vide Agreement No. ________
for Provisioning of mobile services in the areas
affected by Left Wing Extremism (LWE) , the following works have been completed succe
condition of the Agreement :A.
BTS
(i)
(ii)
(iII)
(vi)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
(xi)
(xii)
B.
Battery:
(i)
(ii)
(iII)
(vi)
(v)
(vi)
C.
SMPS Power Plant:
(i)
(ii)
(iII)
(vi)
(v)
(vi)
C.
Solar Power System
(i)
(ii)
(iII)
(vi)
(v)
D.
Antenna for BTS / Microwave (To be provided separately):
(i)
(ii)
(iII)

E.

F.
G.

(vi)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
Backhaul:
(i)
(ii)

Electrical Power Supply:

(i)
Signal Coverage Details:
The actual coverage achieved from the infrastructure site installed is as given b
Type of
Coverage
Indoor
Coverage
Outdoor
Coverage

4 Acceptance Testing of all equipments and infrastructure has been completed by BSNL as p
mentioned above are
5 available for further verification by the appropriate authorities and that the component hav
6 That the components at the infrastructure site shown as installed/ commissioned in the said
7 The date of commissioning of mobile services is____________________________.
8 The contents of the Proforma are true and correct based on the records of the company , n
For on behalf of BSNL

Signature of authorized signatory of BSNL

PROFORMA FOR PHYSICAL / TECHNICAL DETAIL

......................................................., aged about ..............year s\o, d\o Shri

........................................................................................................... do solemnly affirm and state as under:
....................................................................of Bharat sanchar Nigam Limited (BSNL), and I am duly authorized by
................ passed by Board of Directors of the Company to furnish a Certificate on behalf of BSNL.
e agreement signed with Administrator, USOF vide Agreement No. ____________________ Dated__________
g of mobile services in the areas
eft Wing Extremism (LWE) , the following works have been completed successfully as per the specifications in th
he Agreement :Name of the Location:
Name of the district & State:
Location of the Tower (Lat., Long) :
Height of the Tower (in metres)
Make:
Model:
Date of the manufacturing:
Serial No:
Configuration (Sectors and TRX in each sector)
Radiated power:
SACFA Clearance status:
Date of commissioning:

Rated Capacity:
Make:
Type:
Date/ Year of Manufacturing:
Number of Sets
Date of Commissioning:
MPS Power Plant:
Rated Capacity of each Module:
Make:
Type:
Date/ Year of Manufacturing:
Number of Modules
Date of Commissioning:
olar Power System
Capacity
Make:
Type:
Date/ Year of Manufacturing:
Date of Commissioning:
ntenna for BTS / Microwave (To be provided separately):
Type:
Gain:
Beam Width:

Size
Weight
Frequency of operation:
Location on the Tower
Make
Date/ Year of Manufacturing:
Date of Commissioning:
Type of backhaul;
Antenna Specification as per (D) above in case of microwave

ectrical Power Supply:

Wattage Capacity
gnal Coverage Details:
he actual coverage achieved from the infrastructure site installed is as given below:

Coverage Achieved

esting of all equipments and infrastructure has been completed by BSNL as per its extant provisions.
urther verification by the appropriate authorities and that the component have been provided and are functiona
ponents at the infrastructure site shown as installed/ commissioned in the said quarter have been completed on th
mmissioning of mobile services is____________________________.
of the Proforma are true and correct based on the records of the company , no part of it false and nothing has bee

signatory of BSNL

R PHYSICAL / TECHNICAL DETAILS

\o, d\o Shri ..

...... do solemnly affirm and state as under:
gam Limited (BSNL), and I am duly authorized by the resolutions
nish a Certificate on behalf of BSNL.
No. ____________________ Dated__________

mpleted successfully as per the specifications in the terms and

Badgaon
Kanker, Chhattisgarh
200821358046'16.40N 0000'00.00E
40
Alcatel
A9100
NT0723R0480
4/4/2004
43 dBm (20W)
Applied
31.11.2011
200Ah
Exide
VRLA
1
March, 2015
100A
Adore
3 phase
1
March, 2011

OFC
NA

3 phase/ 12 kW

d is as given below:

by BSNL as per its extant provisions.

mponent have been provided and are functional/services are being rendered from the date on which they ha
ned in the said quarter have been completed on the dates as shown above.

e company , no part of it false and nothing has been concealed from.

PROFORMA FOR PHYSIC

1 I............................................................................, aged about ..............year s\o, d\o Shri

resident of .............................................................................................................. do solem
2 That I am .........................................................................of Bharat sanchar Nigam Limited (
dated ............................. passed by Board of Directors of the Company to furnish a Certifica
3 That as per the agreement signed with Administrator, USOF vide Agreement No. ________
for Provisioning of mobile services in the areas
affected by Left Wing Extremism (LWE) , the following works have been completed succe
condition of the Agreement :A.
BTS
(i)
(ii)
(iII)
(vi)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
(xi)
(xii)
B.
Battery:
(i)
(ii)
(iII)
(vi)
(v)
(vi)
C.
SMPS Power Plant:
(i)
(ii)
(iII)
(vi)
(v)
(vi)
C.
Solar Power System
(i)
(ii)
(iII)
(vi)
(v)
D.
Antenna for BTS / Microwave (To be provided separately):
(i)
(ii)
(iII)

E.

F.
G.

(vi)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
Backhaul:
(i)
(ii)

Electrical Power Supply:

electrical P
Signal Coverage Details:
The actual coverage achieved from the infrastructure site installed is as given b
Type of
Coverage
Indoor
Coverage
Outdoor
Coverage

4 Acceptance Testing of all equipments and infrastructure has been completed by BSNL as p
mentioned above are
5 available for further verification by the appropriate authorities and that the component hav
6 That the components at the infrastructure site shown as installed/ commissioned in the said
7 The date of commissioning of mobile services is____________________________.
8 The contents of the Proforma are true and correct based on the records of the company , n
For on behalf of BSNL

Signature of authorized signatory of BSNL

PROFORMA FOR PHYSICAL / TECHNICAL DETAIL

......................................................., aged about ..............year s\o, d\o Shri

........................................................................................................... do solemnly affirm and state as under:
....................................................................of Bharat sanchar Nigam Limited (BSNL), and I am duly authorized by
................ passed by Board of Directors of the Company to furnish a Certificate on behalf of BSNL.
e agreement signed with Administrator, USOF vide Agreement No. ____________________ Dated__________
g of mobile services in the areas
eft Wing Extremism (LWE) , the following works have been completed successfully as per the specifications in th
he Agreement :Name of the Location:
Name of the district & State:
Location of the Tower (Lat., Long) :
Height of the Tower (in metres)
Make:
Model:
Date of the manufacturing:
Serial No:
Configuration (Sectors and TRX in each sector)
Radiated power:
SACFA Clearance status:
Date of commissioning:

Rated Capacity:
Make:
Type:
Date/ Year of Manufacturing:
Number of Sets
Date of Commissioning:
MPS Power Plant:
Rated Capacity of each Module:
Make:
Type:
Date/ Year of Manufacturing:
Number of Modules
Date of Commissioning:
olar Power System
Capacity
Make:
Type:
Date/ Year of Manufacturing:
Date of Commissioning:
ntenna for BTS / Microwave (To be provided separately):
Type:
Gain:
Beam Width:

Size
Weight
Frequency of operation:
Location on the Tower
Make
Date/ Year of Manufacturing:
Date of Commissioning:
Type of backhaul;
Antenna Specification as per (D) above in case of microwave

ectrical Power Supply:

Wattage Capacity
gnal Coverage Details:
he actual coverage achieved from the infrastructure site installed is as given below:

Coverage Achieved

esting of all equipments and infrastructure has been completed by BSNL as per its extant provisions.
urther verification by the appropriate authorities and that the component have been provided and are functiona
ponents at the infrastructure site shown as installed/ commissioned in the said quarter have been completed on th
mmissioning of mobile services is____________________________.
of the Proforma are true and correct based on the records of the company , no part of it false and nothing has bee

signatory of BSNL

R PHYSICAL / TECHNICAL DETAILS

\o, d\o Shri ..

...... do solemnly affirm and state as under:
gam Limited (BSNL), and I am duly authorized by the resolutions
nish a Certificate on behalf of BSNL.
No. ____________________ Dated__________

mpleted successfully as per the specifications in the terms and

Sambalpur
Kanker, Chhattisgarh
201801678102'19.00N 0000'00.00E
40
Alcatel
A9100
NT1020M0096
6/6/2006
43 dBm (20W)
Applied
18.12.2007
200Ah
Exide
VRLA
1
March, 2015
100A
Adore
3 Phase
1
Dec, 2007

OFC
NA

3 phase/ 16 kW

d is as given below:

by BSNL as per its extant provisions.

mponent have been provided and are functional/services are being rendered from the date on which they ha
ned in the said quarter have been completed on the dates as shown above.

e company , no part of it false and nothing has been concealed from.

PROFORMA FOR PHYSIC

1 I............................................................................, aged about ..............year s\o, d\o Shri

resident of .............................................................................................................. do solem
2 That I am .........................................................................of Bharat sanchar Nigam Limited (
dated ............................. passed by Board of Directors of the Company to furnish a Certifica
3 That as per the agreement signed with Administrator, USOF vide Agreement No. ________
for Provisioning of mobile services in the areas
affected by Left Wing Extremism (LWE) , the following works have been completed succe
condition of the Agreement :A.
BTS
(i)
(ii)
(iII)
(vi)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
(xi)
(xii)
B.
Battery:
(i)
(ii)
(iII)
(vi)
(v)
(vi)
C.
SMPS Power Plant:
(i)
(ii)
(iII)
(vi)
(v)
(vi)
C.
Solar Power System
(i)
(ii)
(iII)
(vi)
(v)
D.
Antenna for BTS / Microwave (To be provided separately):
(i)
(ii)
(iII)

E.

F.
G.

(vi)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
Backhaul:
(i)
(ii)

Electrical Power Supply:

(i)
Signal Coverage Details:
The actual coverage achieved from the infrastructure site installed is as given b
Type of
Coverage
Indoor
Coverage
Outdoor
Coverage

4 Acceptance Testing of all equipments and infrastructure has been completed by BSNL as p
mentioned above are
5 available for further verification by the appropriate authorities and that the component hav
6 That the components at the infrastructure site shown as installed/ commissioned in the said
7 The date of commissioning of mobile services is____________________________.
8 The contents of the Proforma are true and correct based on the records of the company , n
For on behalf of BSNL

Signature of authorized signatory of BSNL

PROFORMA FOR PHYSICAL / TECHNICAL DETAIL

......................................................., aged about ..............year s\o, d\o Shri

........................................................................................................... do solemnly affirm and state as under:
....................................................................of Bharat sanchar Nigam Limited (BSNL), and I am duly authorized by
................ passed by Board of Directors of the Company to furnish a Certificate on behalf of BSNL.
e agreement signed with Administrator, USOF vide Agreement No. ____________________ Dated__________
g of mobile services in the areas
eft Wing Extremism (LWE) , the following works have been completed successfully as per the specifications in th
he Agreement :Name of the Location:
Name of the district & State:
Location of the Tower (Lat., Long) :
Height of the Tower (in metres)
Make:
Model:
Date of the manufacturing:
Serial No:
Configuration (Sectors and TRX in each sector)
Radiated power:
SACFA Clearance status:
Date of commissioning:

Rated Capacity:
Make:
Type:
Date/ Year of Manufacturing:
Number of Sets
Date of Commissioning:
MPS Power Plant:
Rated Capacity of each Module:
Make:
Type:
Date/ Year of Manufacturing:
Number of Modules
Date of Commissioning:
olar Power System
Capacity
Make:
Type:
Date/ Year of Manufacturing:
Date of Commissioning:
ntenna for BTS / Microwave (To be provided separately):
Type:
Gain:
Beam Width:

Size
Weight
Frequency of operation:
Location on the Tower
Make
Date/ Year of Manufacturing:
Date of Commissioning:
Type of backhaul;
Antenna Specification as per (D) above in case of microwave

ectrical Power Supply:

Wattage Capacity
gnal Coverage Details:
he actual coverage achieved from the infrastructure site installed is as given below:

Coverage Achieved

esting of all equipments and infrastructure has been completed by BSNL as per its extant provisions.
urther verification by the appropriate authorities and that the component have been provided and are functiona
ponents at the infrastructure site shown as installed/ commissioned in the said quarter have been completed on th
mmissioning of mobile services is____________________________.
of the Proforma are true and correct based on the records of the company , no part of it false and nothing has bee

signatory of BSNL

R PHYSICAL / TECHNICAL DETAILS

\o, d\o Shri ..

...... do solemnly affirm and state as under:
gam Limited (BSNL), and I am duly authorized by the resolutions
nish a Certificate on behalf of BSNL.
No. ____________________ Dated__________

mpleted successfully as per the specifications in the terms and

Hetarkasa
Kanker, Chhattisgarh
201615958116'21.20N 0000'00.00E
40
Alcatel
A9100
NT1020R4279
2/2/2002
43 dBm (20W)
Applied
29.03.2011
200Ah
Exide
VRLA
1
March, 2015
25 A
Delta
1 phase
4
March, 2011

OFC
NA

3 Phase/ 12 kW

d is as given below:

by BSNL as per its extant provisions.

mponent have been provided and are functional/services are being rendered from the date on which they ha
ned in the said quarter have been completed on the dates as shown above.

e company , no part of it false and nothing has been concealed from.

PROFORMA FOR PHYSIC

1 I............................................................................, aged about ..............year s\o, d\o Shri

resident of .............................................................................................................. do solem
2 That I am .........................................................................of Bharat sanchar Nigam Limited (
dated ............................. passed by Board of Directors of the Company to furnish a Certifica
3 That as per the agreement signed with Administrator, USOF vide Agreement No. ________
for Provisioning of mobile services in the areas
affected by Left Wing Extremism (LWE) , the following works have been completed succe
condition of the Agreement :A.
BTS
(i)
(ii)
(iII)
(vi)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
(xi)
(xii)
B.
Battery:
(i)
(ii)
(iII)
(vi)
(v)
(vi)
C.
SMPS Power Plant:
(i)
(ii)
(iII)
(vi)
(v)
(vi)
C.
Solar Power System
(i)
(ii)
(iII)
(vi)
(v)
D.
Antenna for BTS / Microwave (To be provided separately):
(i)
(ii)
(iII)

E.

F.
G.

(vi)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
Backhaul:
(i)
(ii)

Electrical Power Supply:

(i)
Signal Coverage Details:
The actual coverage achieved from the infrastructure site installed is as given b
Type of
Coverage
Indoor
Coverage
Outdoor
Coverage

4 Acceptance Testing of all equipments and infrastructure has been completed by BSNL as p
mentioned above are
5 available for further verification by the appropriate authorities and that the component hav
6 That the components at the infrastructure site shown as installed/ commissioned in the said
7 The date of commissioning of mobile services is____________________________.
8 The contents of the Proforma are true and correct based on the records of the company , n
For on behalf of BSNL

Signature of authorized signatory of BSNL

PROFORMA FOR PHYSICAL / TECHNICAL DETAIL

......................................................., aged about ..............year s\o, d\o Shri

........................................................................................................... do solemnly affirm and state as under:
....................................................................of Bharat sanchar Nigam Limited (BSNL), and I am duly authorized by
................ passed by Board of Directors of the Company to furnish a Certificate on behalf of BSNL.
e agreement signed with Administrator, USOF vide Agreement No. ____________________ Dated__________
g of mobile services in the areas
eft Wing Extremism (LWE) , the following works have been completed successfully as per the specifications in th
he Agreement :Name of the Location:
Name of the district & State:
Location of the Tower (Lat., Long) :
Height of the Tower (in metres)
Make:
Model:
Date of the manufacturing:
Serial No:
Configuration (Sectors and TRX in each sector)
Radiated power:
SACFA Clearance status:
Date of commissioning:

Rated Capacity:
Make:
Type:
Date/ Year of Manufacturing:
Number of Sets
Date of Commissioning:
MPS Power Plant:
Rated Capacity of each Module:
Make:
Type:
Date/ Year of Manufacturing:
Number of Modules
Date of Commissioning:
olar Power System
Capacity
Make:
Type:
Date/ Year of Manufacturing:
Date of Commissioning:
ntenna for BTS / Microwave (To be provided separately):
Type:
Gain:
Beam Width:

Size
Weight
Frequency of operation:
Location on the Tower
Make
Date/ Year of Manufacturing:
Date of Commissioning:
Type of backhaul;
Antenna Specification as per (D) above in case of microwave

ectrical Power Supply:

Wattage Capacity
gnal Coverage Details:
he actual coverage achieved from the infrastructure site installed is as given below:

Coverage Achieved

esting of all equipments and infrastructure has been completed by BSNL as per its extant provisions.
urther verification by the appropriate authorities and that the component have been provided and are functiona
ponents at the infrastructure site shown as installed/ commissioned in the said quarter have been completed on th
mmissioning of mobile services is____________________________.
of the Proforma are true and correct based on the records of the company , no part of it false and nothing has bee

signatory of BSNL

R PHYSICAL / TECHNICAL DETAILS

\o, d\o Shri ..

...... do solemnly affirm and state as under:
gam Limited (BSNL), and I am duly authorized by the resolutions
nish a Certificate on behalf of BSNL.
No. ____________________ Dated__________

mpleted successfully as per the specifications in the terms and

Baijanpuri
Kanker, Chhattisgarh
202123568113'44.30N 0000'00.00E
40
Alcatel
A9100
NT0947R2334
4/4/2004
43 dBm (20W)
Applied
31.03.2011
200Ah
Exide
VRLA
1
March, 2015
100A
Himachal Exicom
3 phase
1
March, 2011

OFC
NA

3 phase/ 12 kW

d is as given below:

by BSNL as per its extant provisions.

mponent have been provided and are functional/services are being rendered from the date on which they ha
ned in the said quarter have been completed on the dates as shown above.

e company , no part of it false and nothing has been concealed from.

PROFORMA FOR PHYSIC

1 I............................................................................, aged about ..............year s\o, d\o Shri

resident of .............................................................................................................. do solem
2 That I am .........................................................................of Bharat sanchar Nigam Limited (
dated ............................. passed by Board of Directors of the Company to furnish a Certifica
3 That as per the agreement signed with Administrator, USOF vide Agreement No. ________
for Provisioning of mobile services in the areas
affected by Left Wing Extremism (LWE) , the following works have been completed succe
condition of the Agreement :A.
BTS
(i)
(ii)
(iII)
(vi)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
(xi)
(xii)
B.
Battery:
(i)
(ii)
(iII)
(vi)
(v)
(vi)
C.
SMPS Power Plant:
(i)
(ii)
(iII)
(vi)
(v)
(vi)
C.
Solar Power System
(i)
(ii)
(iII)
(vi)
(v)
D.
Antenna for BTS / Microwave (To be provided separately):
(i)
(ii)
(iII)

E.

F.
G.

(vi)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
Backhaul:
(i)
(ii)

Electrical Power Supply:

(i)
Signal Coverage Details:
The actual coverage achieved from the infrastructure site installed is as given b
Type of
Coverage
Indoor
Coverage
Outdoor
Coverage

4 Acceptance Testing of all equipments and infrastructure has been completed by BSNL as p
mentioned above are
5 available for further verification by the appropriate authorities and that the component hav
6 That the components at the infrastructure site shown as installed/ commissioned in the said
7 The date of commissioning of mobile services is____________________________.
8 The contents of the Proforma are true and correct based on the records of the company , n
For on behalf of BSNL

Signature of authorized signatory of BSNL

PROFORMA FOR PHYSICAL / TECHNICAL DETAIL

......................................................., aged about ..............year s\o, d\o Shri

........................................................................................................... do solemnly affirm and state as under:
....................................................................of Bharat sanchar Nigam Limited (BSNL), and I am duly authorized by
................ passed by Board of Directors of the Company to furnish a Certificate on behalf of BSNL.
e agreement signed with Administrator, USOF vide Agreement No. ____________________ Dated__________
g of mobile services in the areas
eft Wing Extremism (LWE) , the following works have been completed successfully as per the specifications in th
he Agreement :Name of the Location:
Name of the district & State:
Location of the Tower (Lat., Long) :
Height of the Tower (in metres)
Make:
Model:
Date of the manufacturing:
Serial No:
Configuration (Sectors and TRX in each sector)
Radiated power:
SACFA Clearance status:
Date of commissioning:

Rated Capacity:
Make:
Type:
Date/ Year of Manufacturing:
Number of Sets
Date of Commissioning:
MPS Power Plant:
Rated Capacity of each Module:
Make:
Type:
Date/ Year of Manufacturing:
Number of Modules
Date of Commissioning:
olar Power System
Capacity
Make:
Type:
Date/ Year of Manufacturing:
Date of Commissioning:
ntenna for BTS / Microwave (To be provided separately):
Type:
Gain:
Beam Width:

Size
Weight
Frequency of operation:
Location on the Tower
Make
Date/ Year of Manufacturing:
Date of Commissioning:
Type of backhaul;
Antenna Specification as per (D) above in case of microwave

ectrical Power Supply:

Wattage Capacity
gnal Coverage Details:
he actual coverage achieved from the infrastructure site installed is as given below:

Coverage Achieved

esting of all equipments and infrastructure has been completed by BSNL as per its extant provisions.
urther verification by the appropriate authorities and that the component have been provided and are functiona
ponents at the infrastructure site shown as installed/ commissioned in the said quarter have been completed on th
mmissioning of mobile services is____________________________.
of the Proforma are true and correct based on the records of the company , no part of it false and nothing has bee

signatory of BSNL

R PHYSICAL / TECHNICAL DETAILS

\o, d\o Shri ..

...... do solemnly affirm and state as under:
gam Limited (BSNL), and I am duly authorized by the resolutions
nish a Certificate on behalf of BSNL.
No. ____________________ Dated__________

mpleted successfully as per the specifications in the terms and

Kurri
Kanker, Chhattisgarh
201905188113'05.70N 0000'00.00E
40
Alcatel
A9100
NT1020R4277
2/2/2002
43 dBm (20W)
Applied
3/29/2011
200Ah
Exide
VRLA
1
March, 2015
25A
Delta
1 ph
4
March, 2011

NA

3 phase/12 kW

d is as given below:

by BSNL as per its extant provisions.

mponent have been provided and are functional/services are being rendered from the date on which they ha
ned in the said quarter have been completed on the dates as shown above.

e company , no part of it false and nothing has been concealed from.

PROFORMA FOR PHYSIC

1 I............................................................................, aged about ..............year s\o, d\o Shri

resident of .............................................................................................................. do solem
2 That I am .........................................................................of Bharat sanchar Nigam Limited (
dated ............................. passed by Board of Directors of the Company to furnish a Certifica
3 That as per the agreement signed with Administrator, USOF vide Agreement No. ________
for Provisioning of mobile services in the areas
affected by Left Wing Extremism (LWE) , the following works have been completed succe
condition of the Agreement :A.
BTS
(i)
(ii)
(iII)
(vi)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
(xi)
(xii)
B.
Battery:
(i)
(ii)
(iII)
(vi)
(v)
(vi)
C.
SMPS Power Plant:
(i)
(ii)
(iII)
(vi)
(v)
(vi)
C.
Solar Power System
(i)
(ii)
(iII)
(vi)
(v)
D.
Antenna for BTS / Microwave (To be provided separately):
(i)
(ii)
(iII)

E.

F.
G.

(vi)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
Backhaul:
(i)
(ii)

Electrical Power Supply:

(i)
Signal Coverage Details:
The actual coverage achieved from the infrastructure site installed is as given b
Type of
Coverage
Indoor
Coverage
Outdoor
Coverage

4 Acceptance Testing of all equipments and infrastructure has been completed by BSNL as p
mentioned above are
5 available for further verification by the appropriate authorities and that the component hav
6 That the components at the infrastructure site shown as installed/ commissioned in the said
7 The date of commissioning of mobile services is____________________________.
8 The contents of the Proforma are true and correct based on the records of the company , n
For on behalf of BSNL

Signature of authorized signatory of BSNL

PROFORMA FOR PHYSICAL / TECHNICAL DETAIL

......................................................., aged about ..............year s\o, d\o Shri

........................................................................................................... do solemnly affirm and state as under:
....................................................................of Bharat sanchar Nigam Limited (BSNL), and I am duly authorized by
................ passed by Board of Directors of the Company to furnish a Certificate on behalf of BSNL.
e agreement signed with Administrator, USOF vide Agreement No. ____________________ Dated__________
g of mobile services in the areas
eft Wing Extremism (LWE) , the following works have been completed successfully as per the specifications in th
he Agreement :Name of the Location:
Name of the district & State:
Location of the Tower (Lat., Long) :
Height of the Tower (in metres)
Make:
Model:
Date of the manufacturing:
Serial No:
Configuration (Sectors and TRX in each sector)
Radiated power:
SACFA Clearance status:
Date of commissioning:

Rated Capacity:
Make:
Type:
Date/ Year of Manufacturing:
Number of Sets
Date of Commissioning:
MPS Power Plant:
Rated Capacity of each Module:
Make:
Type:
Date/ Year of Manufacturing:
Number of Modules
Date of Commissioning:
olar Power System
Capacity
Make:
Type:
Date/ Year of Manufacturing:
Date of Commissioning:
ntenna for BTS / Microwave (To be provided separately):
Type:
Gain:
Beam Width:

Size
Weight
Frequency of operation:
Location on the Tower
Make
Date/ Year of Manufacturing:
Date of Commissioning:
Type of backhaul;
Antenna Specification as per (D) above in case of microwave

ectrical Power Supply:

Wattage Capacity
gnal Coverage Details:
he actual coverage achieved from the infrastructure site installed is as given below:

Coverage Achieved

esting of all equipments and infrastructure has been completed by BSNL as per its extant provisions.
urther verification by the appropriate authorities and that the component have been provided and are functiona
ponents at the infrastructure site shown as installed/ commissioned in the said quarter have been completed on th
mmissioning of mobile services is____________________________.
of the Proforma are true and correct based on the records of the company , no part of it false and nothing has bee

signatory of BSNL

R PHYSICAL / TECHNICAL DETAILS

\o, d\o Shri ..

...... do solemnly affirm and state as under:
gam Limited (BSNL), and I am duly authorized by the resolutions
nish a Certificate on behalf of BSNL.
No. ____________________ Dated__________

mpleted successfully as per the specifications in the terms and

Bhanbeda
Kanker, Chhattisgarh
201920638110'33.50N 0000'00.00E
40
Alcatel
A9100
NT0952R2453
4/4/2004
43dBm (20W)
Applied
2/11/2010
200Ah
Exide
VRLA
1
March, 2015
100A

Himachal Exicom
3 ph
1
Feb, 2010

OFC
NA

3 phase/ 16 kW

d is as given below:

by BSNL as per its extant provisions.

mponent have been provided and are functional/services are being rendered from the date on which they ha
ned in the said quarter have been completed on the dates as shown above.

e company , no part of it false and nothing has been concealed from.

PROFORMA FOR PHYSIC

1 I............................................................................, aged about ..............year s\o, d\o Shri

resident of .............................................................................................................. do solem
2 That I am .........................................................................of Bharat sanchar Nigam Limited (
dated ............................. passed by Board of Directors of the Company to furnish a Certifica
3 That as per the agreement signed with Administrator, USOF vide Agreement No. ________
for Provisioning of mobile services in the areas
affected by Left Wing Extremism (LWE) , the following works have been completed succe
condition of the Agreement :A.
BTS
(i)
(ii)
(iII)
(vi)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
(xi)
(xii)
B.
Battery:
(i)
(ii)
(iII)
(vi)
(v)
(vi)
C.
SMPS Power Plant:
(i)
(ii)
(iII)
(vi)
(v)
(vi)
C.
Solar Power System
(i)
(ii)
(iII)
(vi)
(v)
D.
Antenna for BTS / Microwave (To be provided separately):
(i)
(ii)
(iII)

E.

F.
G.

(vi)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
Backhaul:
(i)
(ii)

Electrical Power Supply:

(i)
Signal Coverage Details:
The actual coverage achieved from the infrastructure site installed is as given b
Type of
Coverage
Indoor
Coverage
Outdoor
Coverage

4 Acceptance Testing of all equipments and infrastructure has been completed by BSNL as p
mentioned above are
5 available for further verification by the appropriate authorities and that the component hav
6 That the components at the infrastructure site shown as installed/ commissioned in the said
7 The date of commissioning of mobile services is____________________________.
8 The contents of the Proforma are true and correct based on the records of the company , n
For on behalf of BSNL

Signature of authorized signatory of BSNL

PROFORMA FOR PHYSICAL / TECHNICAL DETAIL

......................................................., aged about ..............year s\o, d\o Shri

........................................................................................................... do solemnly affirm and state as under:
....................................................................of Bharat sanchar Nigam Limited (BSNL), and I am duly authorized by
................ passed by Board of Directors of the Company to furnish a Certificate on behalf of BSNL.
e agreement signed with Administrator, USOF vide Agreement No. ____________________ Dated__________
g of mobile services in the areas
eft Wing Extremism (LWE) , the following works have been completed successfully as per the specifications in th
he Agreement :Name of the Location:
Name of the district & State:
Location of the Tower (Lat., Long) :
Height of the Tower (in metres)
Make:
Model:
Date of the manufacturing:
Serial No:
Configuration (Sectors and TRX in each sector)
Radiated power:
SACFA Clearance status:
Date of commissioning:

Rated Capacity:
Make:
Type:
Date/ Year of Manufacturing:
Number of Sets
Date of Commissioning:
MPS Power Plant:
Rated Capacity of each Module:
Make:
Type:
Date/ Year of Manufacturing:
Number of Modules
Date of Commissioning:
olar Power System
Capacity
Make:
Type:
Date/ Year of Manufacturing:
Date of Commissioning:
ntenna for BTS / Microwave (To be provided separately):
Type:
Gain:
Beam Width:

Size
Weight
Frequency of operation:
Location on the Tower
Make
Date/ Year of Manufacturing:
Date of Commissioning:
Type of backhaul;
Antenna Specification as per (D) above in case of microwave

ectrical Power Supply:

Wattage Capacity
gnal Coverage Details:
he actual coverage achieved from the infrastructure site installed is as given below:

Coverage Achieved

esting of all equipments and infrastructure has been completed by BSNL as per its extant provisions.
urther verification by the appropriate authorities and that the component have been provided and are functiona
ponents at the infrastructure site shown as installed/ commissioned in the said quarter have been completed on th
mmissioning of mobile services is____________________________.
of the Proforma are true and correct based on the records of the company , no part of it false and nothing has bee

signatory of BSNL

R PHYSICAL / TECHNICAL DETAILS

\o, d\o Shri ..

...... do solemnly affirm and state as under:
gam Limited (BSNL), and I am duly authorized by the resolutions
nish a Certificate on behalf of BSNL.
No. ____________________ Dated__________

mpleted successfully as per the specifications in the terms and

Chichgaon
Kanker, Chhattisgarh
201943448106'59.50N 0000'00.00E
40
Alcatel
A9100
NT1020R4232
2/2/2002
43dBm (20W)
Applied
July, 2011
200Ah
Exide
VRLA
1
March, 2015
25A
Delta
1 Phase
3
July, 2011

OFC
NA

3 phase/ 10 kW

d is as given below:

by BSNL as per its extant provisions.

mponent have been provided and are functional/services are being rendered from the date on which they ha
ned in the said quarter have been completed on the dates as shown above.

e company , no part of it false and nothing has been concealed from.

PROFORMA FOR PHYSIC

1 I............................................................................, aged about ..............year s\o, d\o Shri

resident of .............................................................................................................. do solem
2 That I am .........................................................................of Bharat sanchar Nigam Limited (
dated ............................. passed by Board of Directors of the Company to furnish a Certifica
3 That as per the agreement signed with Administrator, USOF vide Agreement No. ________
for Provisioning of mobile services in the areas
affected by Left Wing Extremism (LWE) , the following works have been completed succe
condition of the Agreement :A.
BTS
(i)
(ii)
(iII)
(vi)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
(xi)
(xii)
B.
Battery:
(i)
(ii)
(iII)
(vi)
(v)
(vi)
C.
SMPS Power Plant:
(i)
(ii)
(iII)
(vi)
(v)
(vi)
C.
Solar Power System
(i)
(ii)
(iII)
(vi)
(v)
D.
Antenna for BTS / Microwave (To be provided separately):
(i)
(ii)
(iII)

E.

F.
G.

(vi)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
Backhaul:
(i)
(ii)

Electrical Power Supply:

(i)
Signal Coverage Details:
The actual coverage achieved from the infrastructure site installed is as given b
Type of
Coverage
Indoor
Coverage
Outdoor
Coverage

4 Acceptance Testing of all equipments and infrastructure has been completed by BSNL as p
mentioned above are
5 available for further verification by the appropriate authorities and that the component hav
6 That the components at the infrastructure site shown as installed/ commissioned in the said
7 The date of commissioning of mobile services is____________________________.
8 The contents of the Proforma are true and correct based on the records of the company , n
For on behalf of BSNL

Signature of authorized signatory of BSNL

PROFORMA FOR PHYSICAL / TECHNICAL DETAIL

......................................................., aged about ..............year s\o, d\o Shri

........................................................................................................... do solemnly affirm and state as under:
....................................................................of Bharat sanchar Nigam Limited (BSNL), and I am duly authorized by
................ passed by Board of Directors of the Company to furnish a Certificate on behalf of BSNL.
e agreement signed with Administrator, USOF vide Agreement No. ____________________ Dated__________
g of mobile services in the areas
eft Wing Extremism (LWE) , the following works have been completed successfully as per the specifications in th
he Agreement :Name of the Location:
Name of the district & State:
Location of the Tower (Lat., Long) :
Height of the Tower (in metres)
Make:
Model:
Date of the manufacturing:
Serial No:
Configuration (Sectors and TRX in each sector)
Radiated power:
SACFA Clearance status:
Date of commissioning:

Rated Capacity:
Make:
Type:
Date/ Year of Manufacturing:
Number of Sets
Date of Commissioning:
MPS Power Plant:
Rated Capacity of each Module:
Make:
Type:
Date/ Year of Manufacturing:
Number of Modules
Date of Commissioning:
olar Power System
Capacity
Make:
Type:
Date/ Year of Manufacturing:
Date of Commissioning:
ntenna for BTS / Microwave (To be provided separately):
Type:
Gain:
Beam Width:

Size
Weight
Frequency of operation:
Location on the Tower
Make
Date/ Year of Manufacturing:
Date of Commissioning:
Type of backhaul;
Antenna Specification as per (D) above in case of microwave

ectrical Power Supply:

Wattage Capacity
gnal Coverage Details:
he actual coverage achieved from the infrastructure site installed is as given below:

Coverage Achieved

esting of all equipments and infrastructure has been completed by BSNL as per its extant provisions.
urther verification by the appropriate authorities and that the component have been provided and are functiona
ponents at the infrastructure site shown as installed/ commissioned in the said quarter have been completed on th
mmissioning of mobile services is____________________________.
of the Proforma are true and correct based on the records of the company , no part of it false and nothing has bee

signatory of BSNL

R PHYSICAL / TECHNICAL DETAILS

\o, d\o Shri ..

...... do solemnly affirm and state as under:
gam Limited (BSNL), and I am duly authorized by the resolutions
nish a Certificate on behalf of BSNL.
No. ____________________ Dated__________

mpleted successfully as per the specifications in the terms and

Nehrunagar, Bhanupratappur
Kanker, Chhattisgarh
201757138104'36.70N 0000'00.00E
40
Alcatel
A9100
NT0951R2356
4/4/2004
43dBm (20W)
Applied
Sep, 2011
200Ah
Exide
VRLA
1
March, 2015
100A
Adore
3 Phase
1
Sep, 2011

OFC
NA

3 phase/ 15 kW

d is as given below:

by BSNL as per its extant provisions.

mponent have been provided and are functional/services are being rendered from the date on which they ha
ned in the said quarter have been completed on the dates as shown above.

e company , no part of it false and nothing has been concealed from.

PROFORMA FOR PHYSIC

1 I............................................................................, aged about ..............year s\o, d\o Shri

resident of .............................................................................................................. do solem
2 That I am .........................................................................of Bharat sanchar Nigam Limited (
dated ............................. passed by Board of Directors of the Company to furnish a Certifica
3 That as per the agreement signed with Administrator, USOF vide Agreement No. ________
for Provisioning of mobile services in the areas
affected by Left Wing Extremism (LWE) , the following works have been completed succe
condition of the Agreement :A.
BTS
(i)
(ii)
(iII)
(vi)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
(xi)
(xii)
B.
Battery:
(i)
(ii)
(iII)
(vi)
(v)
(vi)
C.
SMPS Power Plant:
(i)
(ii)
(iII)
(vi)
(v)
(vi)
C.
Solar Power System
(i)
(ii)
(iII)
(vi)
(v)
D.
Antenna for BTS / Microwave (To be provided separately):
(i)
(ii)
(iII)

E.

F.
G.

(vi)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
Backhaul:
(i)
(ii)

Electrical Power Supply:

(i)
Signal Coverage Details:
The actual coverage achieved from the infrastructure site installed is as given b
Type of
Coverage
Indoor
Coverage
Outdoor
Coverage

4 Acceptance Testing of all equipments and infrastructure has been completed by BSNL as p
mentioned above are
5 available for further verification by the appropriate authorities and that the component hav
6 That the components at the infrastructure site shown as installed/ commissioned in the said
7 The date of commissioning of mobile services is____________________________.
8 The contents of the Proforma are true and correct based on the records of the company , n
For on behalf of BSNL

Signature of authorized signatory of BSNL

PROFORMA FOR PHYSICAL / TECHNICAL DETAIL

......................................................., aged about ..............year s\o, d\o Shri

........................................................................................................... do solemnly affirm and state as under:
....................................................................of Bharat sanchar Nigam Limited (BSNL), and I am duly authorized by
................ passed by Board of Directors of the Company to furnish a Certificate on behalf of BSNL.
e agreement signed with Administrator, USOF vide Agreement No. ____________________ Dated__________
g of mobile services in the areas
eft Wing Extremism (LWE) , the following works have been completed successfully as per the specifications in th
he Agreement :Name of the Location:
Name of the district & State:
Location of the Tower (Lat., Long) :
Height of the Tower (in metres)
Make:
Model:
Date of the manufacturing:
Serial No:
Configuration (Sectors and TRX in each sector)
Radiated power:
SACFA Clearance status:
Date of commissioning:

Rated Capacity:
Make:
Type:
Date/ Year of Manufacturing:
Number of Sets
Date of Commissioning:
MPS Power Plant:
Rated Capacity of each Module:
Make:
Type:
Date/ Year of Manufacturing:
Number of Modules
Date of Commissioning:
olar Power System
Capacity
Make:
Type:
Date/ Year of Manufacturing:
Date of Commissioning:
ntenna for BTS / Microwave (To be provided separately):
Type:
Gain:
Beam Width:

Size
Weight
Frequency of operation:
Location on the Tower
Make
Date/ Year of Manufacturing:
Date of Commissioning:
Type of backhaul;
Antenna Specification as per (D) above in case of microwave

ectrical Power Supply:

Wattage Capacity
gnal Coverage Details:
he actual coverage achieved from the infrastructure site installed is as given below:

Coverage Achieved

esting of all equipments and infrastructure has been completed by BSNL as per its extant provisions.
urther verification by the appropriate authorities and that the component have been provided and are functiona
ponents at the infrastructure site shown as installed/ commissioned in the said quarter have been completed on th
mmissioning of mobile services is____________________________.
of the Proforma are true and correct based on the records of the company , no part of it false and nothing has bee

signatory of BSNL

R PHYSICAL / TECHNICAL DETAILS

\o, d\o Shri ..

...... do solemnly affirm and state as under:
gam Limited (BSNL), and I am duly authorized by the resolutions
nish a Certificate on behalf of BSNL.
No. ____________________ Dated__________

mpleted successfully as per the specifications in the terms and

Keoti
Kanker, Chhattisgarh
201351558105'15.30N 0000'00.00E
40
Alcatel
A9100
NT0935R1521
4/4/2004
43dBm (20W)
Applied
3/29/2011
200Ah
Exide
VRLA
1
March, 2015
100A
Adore
3 Phase
1
March, 2011

OFC
NA

3 phase/ 12 kW

d is as given below:

by BSNL as per its extant provisions.

mponent have been provided and are functional/services are being rendered from the date on which they ha
ned in the said quarter have been completed on the dates as shown above.

e company , no part of it false and nothing has been concealed from.

PROFORMA FOR PHYSIC

1 I............................................................................, aged about ..............year s\o, d\o Shri

resident of .............................................................................................................. do solem
2 That I am .........................................................................of Bharat sanchar Nigam Limited (
dated ............................. passed by Board of Directors of the Company to furnish a Certifica
3 That as per the agreement signed with Administrator, USOF vide Agreement No. ________
for Provisioning of mobile services in the areas
affected by Left Wing Extremism (LWE) , the following works have been completed succe
condition of the Agreement :A.
BTS
(i)
(ii)
(iII)
(vi)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
(xi)
(xii)
B.
Battery:
(i)
(ii)
(iII)
(vi)
(v)
(vi)
C.
SMPS Power Plant:
(i)
(ii)
(iII)
(vi)
(v)
(vi)
C.
Solar Power System
(i)
(ii)
(iII)
(vi)
(v)
D.
Antenna for BTS / Microwave (To be provided separately):
(i)
(ii)
(iII)

E.

F.
G.

(vi)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
Backhaul:
(i)
(ii)

Electrical Power Supply:

(i)
Signal Coverage Details:
The actual coverage achieved from the infrastructure site installed is as given b
Type of
Coverage
Indoor
Coverage
Outdoor
Coverage

4 Acceptance Testing of all equipments and infrastructure has been completed by BSNL as p
mentioned above are
5 available for further verification by the appropriate authorities and that the component hav
6 That the components at the infrastructure site shown as installed/ commissioned in the said
7 The date of commissioning of mobile services is____________________________.
8 The contents of the Proforma are true and correct based on the records of the company , n
For on behalf of BSNL

Signature of authorized signatory of BSNL

PROFORMA FOR PHYSICAL / TECHNICAL DETAIL

......................................................., aged about ..............year s\o, d\o Shri

........................................................................................................... do solemnly affirm and state as under:
....................................................................of Bharat sanchar Nigam Limited (BSNL), and I am duly authorized by
................ passed by Board of Directors of the Company to furnish a Certificate on behalf of BSNL.
e agreement signed with Administrator, USOF vide Agreement No. ____________________ Dated__________
g of mobile services in the areas
eft Wing Extremism (LWE) , the following works have been completed successfully as per the specifications in th
he Agreement :Name of the Location:
Name of the district & State:
Location of the Tower (Lat., Long) :
Height of the Tower (in metres)
Make:
Model:
Date of the manufacturing:
Serial No:
Configuration (Sectors and TRX in each sector)
Radiated power:
SACFA Clearance status:
Date of commissioning:

Rated Capacity:
Make:
Type:
Date/ Year of Manufacturing:
Number of Sets
Date of Commissioning:
MPS Power Plant:
Rated Capacity of each Module:
Make:
Type:
Date/ Year of Manufacturing:
Number of Modules
Date of Commissioning:
olar Power System
Capacity
Make:
Type:
Date/ Year of Manufacturing:
Date of Commissioning:
ntenna for BTS / Microwave (To be provided separately):
Type:
Gain:
Beam Width:

Size
Weight
Frequency of operation:
Location on the Tower
Make
Date/ Year of Manufacturing:
Date of Commissioning:
Type of backhaul;
Antenna Specification as per (D) above in case of microwave

ectrical Power Supply:

Wattage Capacity
gnal Coverage Details:
he actual coverage achieved from the infrastructure site installed is as given below:

Coverage Achieved

esting of all equipments and infrastructure has been completed by BSNL as per its extant provisions.
urther verification by the appropriate authorities and that the component have been provided and are functiona
ponents at the infrastructure site shown as installed/ commissioned in the said quarter have been completed on th
mmissioning of mobile services is____________________________.
of the Proforma are true and correct based on the records of the company , no part of it false and nothing has bee

signatory of BSNL

R PHYSICAL / TECHNICAL DETAILS

\o, d\o Shri ..

...... do solemnly affirm and state as under:
gam Limited (BSNL), and I am duly authorized by the resolutions
nish a Certificate on behalf of BSNL.
No. ____________________ Dated__________

mpleted successfully as per the specifications in the terms and

Koylibeda
Kanker Chhattisgarh
195752158059'54.90N 0000'00.00E
40
Alcatel
A9100
NT0723R0465
4/4/2004
43dBm (20W)
Applied
July, 2011
200AH
Exide
VRLA
2
March, 2015
25A
Altec
1 phase
3
Aug, 2011

OFC
NA

3 phase/ 15 kW

d is as given below:

by BSNL as per its extant provisions.

mponent have been provided and are functional/services are being rendered from the date on which they ha
ned in the said quarter have been completed on the dates as shown above.

e company , no part of it false and nothing has been concealed from.

PROFORMA FOR PHYSIC

1 I............................................................................, aged about ..............year s\o, d\o Shri

resident of .............................................................................................................. do solem
2 That I am .........................................................................of Bharat sanchar Nigam Limited (
dated ............................. passed by Board of Directors of the Company to furnish a Certifica
3 That as per the agreement signed with Administrator, USOF vide Agreement No. ________
for Provisioning of mobile services in the areas
affected by Left Wing Extremism (LWE) , the following works have been completed succe
condition of the Agreement :A.
BTS
(i)
(ii)
(iII)
(vi)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
(xi)
(xii)
B.
Battery:
(i)
(ii)
(iII)
(vi)
(v)
(vi)
C.
SMPS Power Plant:
(i)
(ii)
(iII)
(vi)
(v)
(vi)
C.
Solar Power System
(i)
(ii)
(iII)
(vi)
(v)
D.
Antenna for BTS / Microwave (To be provided separately):
(i)
(ii)
(iII)

E.

F.
G.

(vi)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
Backhaul:
(i)
(ii)

Electrical Power Supply:

(i)
Signal Coverage Details:
The actual coverage achieved from the infrastructure site installed is as given b
Type of
Coverage
Indoor
Coverage
Outdoor
Coverage

4 Acceptance Testing of all equipments and infrastructure has been completed by BSNL as p
mentioned above are
5 available for further verification by the appropriate authorities and that the component hav
6 That the components at the infrastructure site shown as installed/ commissioned in the said
7 The date of commissioning of mobile services is____________________________.
8 The contents of the Proforma are true and correct based on the records of the company , n
For on behalf of BSNL

Signature of authorized signatory of BSNL

PROFORMA FOR PHYSICAL / TECHNICAL DETAIL

......................................................., aged about ..............year s\o, d\o Shri

........................................................................................................... do solemnly affirm and state as under:
....................................................................of Bharat sanchar Nigam Limited (BSNL), and I am duly authorized by
................ passed by Board of Directors of the Company to furnish a Certificate on behalf of BSNL.
e agreement signed with Administrator, USOF vide Agreement No. ____________________ Dated__________
g of mobile services in the areas
eft Wing Extremism (LWE) , the following works have been completed successfully as per the specifications in th
he Agreement :Name of the Location:
Name of the district & State:
Location of the Tower (Lat., Long) :
Height of the Tower (in metres)
Make:
Model:
Date of the manufacturing:
Serial No:
Configuration (Sectors and TRX in each sector)
Radiated power:
SACFA Clearance status:
Date of commissioning:

Rated Capacity:
Make:
Type:
Date/ Year of Manufacturing:
Number of Sets
Date of Commissioning:
MPS Power Plant:
Rated Capacity of each Module:
Make:
Type:
Date/ Year of Manufacturing:
Number of Modules
Date of Commissioning:
olar Power System
Capacity
Make:
Type:
Date/ Year of Manufacturing:
Date of Commissioning:
ntenna for BTS / Microwave (To be provided separately):
Type:
Gain:
Beam Width:

Size
Weight
Frequency of operation:
Location on the Tower
Make
Date/ Year of Manufacturing:
Date of Commissioning:
Type of backhaul;
Antenna Specification as per (D) above in case of microwave

ectrical Power Supply:

Wattage Capacity
gnal Coverage Details:
he actual coverage achieved from the infrastructure site installed is as given below:

Coverage Achieved

esting of all equipments and infrastructure has been completed by BSNL as per its extant provisions.
urther verification by the appropriate authorities and that the component have been provided and are functiona
ponents at the infrastructure site shown as installed/ commissioned in the said quarter have been completed on th
mmissioning of mobile services is____________________________.
of the Proforma are true and correct based on the records of the company , no part of it false and nothing has bee

signatory of BSNL

R PHYSICAL / TECHNICAL DETAILS

\o, d\o Shri ..

...... do solemnly affirm and state as under:
gam Limited (BSNL), and I am duly authorized by the resolutions
nish a Certificate on behalf of BSNL.
No. ____________________ Dated__________

mpleted successfully as per the specifications in the terms and

Tadoki
Kanker Chhattisgarh
195752698109'28.70N 0000'00.00E
40
Alcatel
A9100
NT1019M0002
666
43dBm (20W)
Applied
Sep, 2011
200 AH
Exide
VRLA
1
3/1/2015
25A
Delta
1 phase
7
9/1/2011

OFC
NA

3 phase/12 kW

d is as given below:

by BSNL as per its extant provisions.

mponent have been provided and are functional/services are being rendered from the date on which they ha
ned in the said quarter have been completed on the dates as shown above.

e company , no part of it false and nothing has been concealed from.