CALCUTTA TELEPHONES
MANDATE FORM FOR GOVT./PSU/BANK EMPLOYEE
To
Divisional Engineer ( New Services )/NSS,
Bharat Sanchar Nigam Limited,
Calcutta Telephones
Sub: Mandate form for Government/Public Sector Units (PSU) /Bank employees
( For exemption from security deposit for Post-Paid connection of BSNL Mobile, Kolkata)
I Sri _______________________________________________, has been working as ________________(designation) since _________in
the office __________________, which is a Govt./ PSU concern. I am interested to take a Post-Paid mobile connection from BSNL, Kolkata
for my personal use. In this connection I affirm the following statements and declaration:
Name & address of my office: _______________________________________
________________________________________
_______________________________________
Date of my superannuation : ______________________________
I have not availed myself of this facility for any other mobile connection from BSNL. I will be totally responsible for the usage of this mobile
connection and payment of bills against this connection.
I understand that in case ISD is required in my mobile connection, security deposit is payable as per provision in the tariff for Cellular Mobile
Service of BSNL, Kolkata.
I understand that I may be required to deposit Security Deposit at the rate decided by BSNL in case revision or introduction of new tariff
scheme at the full discretion of BSNL.
* I am opting for payment of my monthly mobile bills through ECS, the prescribed form duly filled in is attached.
I will be liable to give immediate intimation to BSNL authority in case of my transfer, leaving this particular service, change of service,
retrenchment or superannuation. Under such circumstances my mobile connection, if I like to continue, will be guided by the norms & rules of
BSNL.
Date:
Signature of the applicant:
Place :
Name of the applicant :
Phone: _______________________ (Office) _____________________ (Residence)
Certificate from controlling officer ( not below the rank of Manager/ Group A officer)
Certified that the above facts are true to the best of my knowledge and official records in my office.
Name:
Designation with Office seal:
Signature:
Note: * Mandatory for Bank Employee.