Sim Block Form

Cleaning/Correction of Mobile Sim Record UNDERTAKING By Complainant: I Mr. /Ms ____________________________________________________ S/O, D/O _____________________________________________________ Resident of ___________________________________________________ do hereby solemnly that following SIMs/connections are in my use:A: B: C: D: E: F:

_____________________ _____________________ _____________________ _____________________ _____________________ _____________________

G: H: I: J: K: L:

_____________________ _____________________ _____________________ _____________________ _____________________ _____________________

Please block any other number(s) issued / registered against my NIC/CNIC number forthwith and oblige. Signature of the complainant:

_____________________

Thumbs impression of the complainant:

_____________________

Date of Complaint:

_____________________ (To be filled by Mobile Company)

By M/s _____________________

Complaint Ref #: _____________________

M/s_____________________ do herby undertake that it shall regularize/block all mobile number(s) issued against above mentioned NIC/CNIC, other then above mentioned mobile numbers, within 45 days of this application / complaint and will update its database accordingly. Customer Service Center Representative Name

_____________________

Customer Service Center Representative ID

_____________________

Customer Service Center Representative Sign

_____________________

Note: Documents to Checked / Attached. A: -

SMS received from “668” seen on complainant mobile phone.

Y/N

B: - Original NIC/CNIC seen (incase of family member, then for both Y / N intended and original complainant). C: -

NIC/CNIC copy obtained and attached with this form.

Y/N