Online Application Form

To,

Abhi-Man Tele-Com Ltd

A1/A2, Apeksha Enclave,

Mahavir Nagar, Kandivali (W),

Mumbai - 400067.


Dear Sir,

	I/We would like to avail the following services in addition to Intercom Facility

Services Required :

LOCAL

STD

ISD

I/We, the undersigned apply for the Digital Communication Services that you propose to provide within the area of Mahavir Nagar, I/We furnish below my/our particulars.

Name of Applicant*

Name of the Joint Applicant if any

Name of the Firm

Status : Residential / Commercial*

Address*

Billing Address*

Address for Correspondence / Installation*

PAN No / Form 60

Ph No

Fax

Mobile / Pager

Email*

I/We hereby declare that your rules and regulations / Terms & Conditions current as well as amended from time to time are acceptable to me/us.