Registration Form for Top Corporate and Small and Medium Enterprise (SME)

customers of Tata Indicom for Online@Tata Indicom

Name of the Company/Organization

Account Number
Contact E-mail ID
Number of Telephone Lines held
Telephone Number (1)
Telephone Number (2)
Telephone Number (3)
Telephone Number (4)
Telephone Number (5)
Telephone Number (6)
Telephone Number (7)
Telephone Number (8)
Telephone Number (9)
Telephone Number (10)

I acknowledge that the above-mentioned details are correct and verified and are
submitted to Tata Indicom for the online access of our account.

Place:
Date:

(Signature)

(Name In Block Letters)

(Designation)