Address Verification Form
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Address Verification Form Date of Varification Account No Contact No Name of Customer Address 1 Address 2 City Alternate Contact No Status:
Have You Taken Connection From BSNL? (Yes/No/Not Aware) Proof Verified to Confirm the Address: < 1 > Electric/Telephone Bill < 2 > Bank Statement < 3 > Any Photo ID with Photo < 4 > Gas Slip/Ration Card/LIC < 5 > Rental Agreement < 6 > Other (Please Mention)
Signature of Customer / Person Met
Name of Customer / Person Met with Designation
Have You Taken Connection From BSNL? (Yes/No/Not Aware) Proof Verified to Confirm the Address: < 1 > Electric/Telephone Bill < 2 > Bank Statement < 3 > Any Photo ID with Photo < 4 > Gas Slip/Ration Card/LIC < 5 > Rental Agreement < 6 > Other (Please Mention)
Signature of Customer / Person Met
Name of Customer / Person Met with Designation
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