den satellite network pvt. ltd.ashwinicablevision.in/customer_registration_form.pdf · for office...

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FOR OFFICE USE ONLY 1. SUBSCRIBER INFORMATION (PLEASE FILL IN CAPITAL LETTERS) Mobile No.: Home Telephone Installation Address: District State City Pin You are: Existing Subscriber New Subscriber E-mail ID: PASTE STB STICKER HERE DEN SATELLITE NETWORK PVT. LTD. 409/412, Kailas Industrial Complex, Veer Savarkar Marg, Parksite, Vikhroli - East, Mumbai - 400079. Tel. No. 022-39541515. Email: [email protected] Smart Card No./ VC No. : STB ID: LCO NETWORK NAME:____________________________________ LCO CODE: AREA:_________________________ CUSTOMER REGISTRATION FORM DATE: Customer Signature NOTE: 1) PLEASE ATTACHED SELF ATTESTED RESIDENTIAL & PHOTO ID PROOF ALONG WITH THIS FORM. 2) RENTAL RESIDENTIAL CUSTOMERS, PLEASE ATTACHED PHOTO COPY OF THE FIRST PAGE OF RENTAL AGREEMENT. LCO Stamp & Signature

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Page 1: DEN SATELLITE NETWORK PVT. LTD.ashwinicablevision.in/Customer_Registration_Form.pdf · for office use only 1. subscriber information (please fill in capital letters) mobile no.: home

FOR OFFICE USE ONLY

1. SUBSCRIBER INFORMATION (PLEASE FILL IN CAPITAL LETTERS)

Mobile No.: Home Telephone

Installation Address:

District

State

City

Pin

You are: Existing Subscriber New Subscriber

E-mail ID:

PASTE STBSTICKER HERE

DEN SATELLITE NETWORK PVT. LTD.409/412, Kailas Industrial Complex, Veer Savarkar Marg,

Parksite, Vikhroli - East, Mumbai - 400079.Tel. No. 022-39541515. Email: [email protected]

Smart Card No./ VC No. : STB ID:

LCO NETWORK NAME:____________________________________

LCO CODE:

AREA:_________________________

CUSTOMER REGISTRATION FORMDATE:

Customer Signature

NOTE:

1) PLEASE ATTACHED SELF ATTESTED RESIDENTIAL & PHOTO ID PROOF ALONG WITH THIS FORM.

2) RENTAL RESIDENTIAL CUSTOMERS, PLEASE ATTACHED PHOTO COPY OF THE FIRST PAGE OF RENTAL AGREEMENT.

LCO Stamp & Signature

Page 2: DEN SATELLITE NETWORK PVT. LTD.ashwinicablevision.in/Customer_Registration_Form.pdf · for office use only 1. subscriber information (please fill in capital letters) mobile no.: home

FOR OFFICE USE ONLY

1. SUBSCRIBER INFORMATION (PLEASE FILL IN CAPITAL LETTERS)

Mobile No.: Home Telephone

Installation Address:

District

State

City

Pin

You are: Existing Subscriber New Subscriber

E-mail ID:

PASTE STBSTICKER HERE

KONARK IP DOSSIER PVT. LTD.KONARK PLAZA, 1ST FLOOR, NEAR SAPNA GARDEN,

ULHASNAGAR - 421003, THANE, MAHARASHTRA. TEL. 0251-2701384.EMAIL: [email protected]

Smart Card No./ VC No. : STB ID:

LCO NETWORK NAME:____________________________________

LCO CODE:

AREA:_________________________

CUSTOMER REGISTRATION FORM

NOTE:

1) PLEASE ATTACHED SELF ATTESTED RESIDENTIAL & PHOTO ID PROOF ALONG WITH THIS FORM.

2) RENTAL RESIDENTIAL CUSTOMERS, PLEASE ATTACHED PHOTO COPY OF THE FIRST PAGE OF RENTAL AGREEMENT.

DATE:

LCO Stamp & Signature Customer Signature

K

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