1. a) Name of the Subscriber/Transferer :

b) Address at which the conn. is working :

c) Address for future correspondence :

if any (or transferee)

d) Whether the telephone belong to

Co., Firm or individual :

2. a) Telephone No. to be transferred :

b) Whether any other telephone working :

for the transferee.

c) Date of installation (Telephone to :

be transferred.

d) Regn. No. & Date against which :

telephone has been installed.

e) Category of Telephone :

(OYT/G & N-OYT-G only permitted)

3. a) Name of the party to whom the :

telephone connection is to be

transferred (Transferece)

b) Whether the connection is required :

for Co. Firm or individual

c) Correspondence Address & Telephone :

Nos. of the Transferce

d) Other telephone numbers working in :

the name of the Transferce

4. Name (s) of the Proprietor/partners of :

the applicant firm before transfer

5. Name (s) of the Proprietor/partners :

of the firm after transfer

Name of the Directors etc. (Before & after transfer) :

Before transfer.................. After transfer..................

Place : New Delhi

Date :.................... Signature(s) of the Transfere(s)

Place :

Date :.................... Signature(s) of the Transfere(s)

Note : This form must be submitted alongwith the following documents :

i) An affidavit on a stamp paper of Rs. 5/- by the transfer (as per

annexure-III)

ii) An indeminity Bond on a stamp paper of Rs. 10/- (as per annexure-II)

Note : i) Signature Of Subscriber Should be Attested By Delhi Based Gazetted Officer 1st Class Magistrate/ manager Schedule Bank

ii) Photocopy Of Last Paid Bill Should Be Attached After Making Payment Of Bills.

6. FOR OFFICE USE ONLY

Certified that all the bills issued upto the date of application for

transfer i.e.---------------------have been paid or a total Rs.-----------------

is outstanding above telephone as on ----------------------------

I, Shri/Smt./Km.-----------------------------------------We, M/S---------------

of----------------------------------------------Address------------------------

-------------------------------------------------------------------------------

do hereby agree to surrender to the President of India (hereinafter called. The

Government) the telephone connection number --------------subscriber by---------

further undertake to idemnity the Govt. and keep them indemnified against any

loss, demand, damage, claim cost. charges or expenses incurred by or made

against them in respect of the transfer of the said telephone connection to

my/our name in the even of my legal hair/next of kin or representative of the

subscriber----------------------- or any other person what over hereafter making

a claim (Name of Subscriber)

in respect of the said telephone to pay all outstanding dues, if any, of the

above mentioned telephone whether a bill for that has been issued to the earlier

transfer or not.

Witness :

1. Signed this on -----------------------------

Day of -------------------------------------

Signature ----------------------------------

2. Designation --------------------------------

Executed before the oath

Administration Magistrate

or Nortary Public

Signature & Seal

Consent-cum-declaration affidavit on stamp paper of Rs.5/- for Transfer of

Telephone worked beyond the period of one year from its date of installation.

I/We, Shri/Smt./Kum./M/s. ------------------------------------------------------

--------------------------------------------------------------------------------

RESIDING AT --------------------------------------------------------------------

am/are the bonafide subscriber of Telephone Connection No. ------------ and do

hereby declare solemn affirmation that:-

I/We do hereby give irrevocable and absolute consent to transfer the above

mentioned connection to the name of Shri./Smt./Kum./M/s. -----------------------

(Name Address)

--------------------------------------------------------------------------------

of transfer of the said telephone

(2) Further, I shall have no claim whatsoever hereafter at any time for the said

telephone connection, once the transfer formalities are completed and the

telephone is transferred in the name of the Transferee viz.---------------------

--------------------------------------------------------------------------------

Witness :

1. Signature of Deponent

2.

Executed before the oath

Administration Magistrate

or Nortary Public

Signature & Seal :

Name :