Cef - Delhi

Customer Engagement Form- POSTPAID TelecomCircle - Delhi Please fill this engagement formin capital letters with black ink.

CEF No. -

Paste you self attested passport size photograph

Fields marked in Red are complusory Activation date

Product Type: Mobile SubscriptionDetails

Blackberry

Data Card

Donot Staple

Others:

Aircel No. SimNo. Title

Mr.

Mrs.

Ms.

Gender

M

F

Age:

Date of Birth

Name Father's/Mother's/ Husband's Name Nationality:

Marital Status

If you are a FOREIGN NATIONAL, please fill passport No.

CompanyName:

Married

Sing

(For COCP

Present Address: (Address for verification and Billing)

City/Village:

Nearest Landmark:

District:

State:

Pin Code

Alternate no:

Permanent Address: (Supported by Documentary Proofs)

City/Village: District:

Nearest Landmark: State:

Pin Code

Alternate no:

Email: PAN/GIRNo.

Please fill up form60 or 61(whichever is applicable) given below in case you do not have PAN/GIR No. If you wish to register your connection for NDNC (National Do Not Call), please send SMS <START NDNC>to 1909 or call at 1909

ForCompanyOwnedconnections (Please providedetails) Name of Authorized Signatory

Designation: TelephoneNo:

e mail ID:

DocumentaryProofs P roof of Identity (P OI) P roof of Address (P OA) Employment P roof

POI No. : POANo. :

(For corporate only)

FORM 60

FORM 61

i) Details of Transaction: ii) Amount of Transaction: iii) Are you assessed to Tax: Y ES/NO If Y es, a) Details of ward/circle/range where the last return of income tax filed b) Reasons for not having PAN or GIR No.

Details of Documents being produced in support of address I hereby declare that mny source of income is from agriculture and I am not required to pay income tax on any other income if any, Signature of the Declarant

OutstationSubscriber / ForeignNational (provide detailsoflocal reference) MyLocal reference and address is: Local No: 1)

State: Pin Code: TariffPlan, SchemesandPayment Details Bill Plan Name: Payment Details Enrollment Fee: (A) Deposit (B) Grand Total (A+B) Mode of Payment: Cheque/DDDetails:

Cash

Cheque Card Bank name:

2)

3)

ServicerequestedandDeposit (B) ISD

DD

STD

National Roaming

International Roaming

CLIP

Others, if any: Service Deposit: Subscription deposit: Total Deposit: Card Details:

Cheque to be made in favor of "Aircel Limited"

Declaration I/We declare and undertake that the above information provided by me/us is true and correct in all respects. I also undertake the responsibility for the correctness and genuineness of the documents submitted by me/us in regard to the Aircel Postpaid mobile subscription. I/we have read and fully understood the termand conditions mentioned overleaf and unconditionally accept themas binding on me/us. I/We have understood all the rates, tariffs and other related conditions at which telecommunication service will be provided inside and outside India as applicable as on this date and as amended fromtime to time. I/We undertake that in the event this connection is used for any telemarketing purpose I /We shall be solely responsible for registration of the connection with the mandated statutory authorities. Date: Signature of the customer/Authorized signatory along with seal To be filled by Retailer

To be filled by Distributor

C ustom er Urban Rural I/We hereby undertake and confirmthat I/We have seen the customer and certify that (a) The/ Registered Office: Regional Office Aircel Limited 2 & 3,by Local Shopping complex, Sector B, Pocket 1, Vasant Kunj, New Delhi –I/We 110070 / 5th Floor, Plaza, 769,docum Anna Salai, Chennai-6000002 Aircel CEF has been duly filledPlot andNo. signed applicant only in my presence; (b) The photograph confirm thatSpencer all the necessary entary proof, signature and photograph of the applicant Delhi Post-paid Customer Care No, - 9716012345 or 121 (from Aircel Mobile). Customer care email address: [email protected]. Website: www.aircel.com submitted has been matched with the applicant; (c) The Identity and address submitted are are in order and I/we are activating the SIM card after the verification of the details provided in the verified with the respective originals and are true; (d) Details mentioned on the CEF match with engagement formwith the supporting documents