Bharti Airtel Limited (Mobile Services)

Customer Application Form no Customer Application Date __________________

Purchase Order No ---------- Purchase Order Date __________________

Sr. DESCRIPTION Detail

1 Name of company

2 Number of Connections requested*

*details of mobile numbers to be attached as per Annexure – I

Customer undertaking

I hereby confirm that an order for the mentioned mobile numbers has been placed and the user name along with their designation is
provided against these mobile numbers as per the annexure1 containing __01__pages.

I will update you on any name change happening in future due to transfer of mobile numbers, within a week of any such change.

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Customer Signature (Authorized signatory)

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Company Stamp

Annexure – I
SLNO Mobile Number SIM Number Name Disgnation

2
3
4
5

Customer Signature (Authorized signatory) ____________________________________(all pages of annexure 1)

________________________________________________________________(all pages of annexure 1)

Company Stamp