BHARAT SANCHAR NIGAM LIMITED aAf ffiix self

attested
a
(A Govt. of India Enterprise ) passport size
photo of
s
transferee
of(Mandatory)
Form No. Com – 12

APPLICATION FOR NAME TRANSFER OF TELEPHONES

TELEPHONE NO.(s) --------------------------------------------

1. Name of the original Subscriber -------------------------------------------------------------------------------------

2. Address at which the connection is working -----------------------------------------------------------------------

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3. Facility already exists in Telephone a) STD b) ISD c) Centrex d) Broadband e) IPTV

( pl. put the tick mark ) f) DIAS g) PA / PF/Free connection. h) Others -------------------

4 Name of the party to whom the Tele. No. is going to be transferred ------------------------------------------

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5. Address of the new party ----------------------------------------------------------------------------------------------

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. Nationality ------------------------ Age ----------------------- Occupation -----------------------------------------

6 Reason of Transfer -- Death / Not required by original subscriber / Others ------------------------------------

7 Relationship between the present subscriber and transferee, if any ; ----------------------------------------------

8 In the case of transfer on account of death of original hirer ; Date of death ------------------------------------

9. Documents to be submitted by transferee :---- ( please put the tick mark )

a) Self attested passport size photograph b) Photo I.D. proof
c) Address proof d) Undertakings (any one) =. Annexure – I/ Annexure – II / Annexure - III
e) Last paid bill copy f) Death certificate g) Succession certificate h) others ---------------

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Signature of the Transferer & date Signature of the Transferee & date

10 Name (s) of the existing Proprietors /Partners/ Directors (in case of a firm/company ) :--

11. Name(s) of the new Proprietors / Partners/Directors after name transfer (in case of a firm/company) :--

12. Signature(s) of the new proprietors/partners/directors Signature(s) of the existing proprietors/partners/directors

(with official seal) ( with official seal )

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 INSTRUCTIONS for change / transfer of name of telephone
A. Under category of General Transfer ( within blood relation )
1. In case of death :--
I. The transfer is permissible with no limitation of period for which it is working in the name of
subscriber.
II. Name can be changed to any relative who has bonafide existence at the same premises with
undertaking
in Annexure – I., in absence of demand from a legal heir
III In case of demand from a legal heir also an undertaking in Annexure – I shall be submitted
if he fails to submit succession certificate or no objection certificate from other legal heir./heirs .
IV Documents to be submitted ---- a) Photo I.D. proof of the Transferee b) Death Certificate
c) Proof of relationship within blood relation, if any d) Address proof should be same as
installation address e ) Self attested passport Photograph of transferee f) Annexure - I
e ) Proof of Legal Heir / Succession certificate, if any.
2. In other cases : ---
I. The transfer is permissible with no limitation of period for which it is working in the name of
subscriber.
II. Consent letters / declarations in Annex – II shall be submitted by transferer and transferee.
III. Proof of relationship shall be submitted for transfer within blood relation.
IV. In absence of any legal document, name can be changed to any relative who has bonafide
existence at the same premises with undertaking in Annexure – II..
V. Documents to be submitted ----- a) Photo I.D. proof of the Transferee b) Proof of relationship
within blood relation, if any c) Address proof of transferee should be same as installation
address d ) Self attested passport Photograph of transferee one copy.
d) Consent letters / declaration, in Annex – II .
B. Under category of Third Party Transfer ( No blood relation )
. 1. In case of individual Subscriber : --
I The transfer is permissible with no limitation of period.
II In absence of demand from a legal heir(s), name can be changed to any person who has bonafide
existence at the same premises, with undertaking in Annexure – III..
III. Documents to be submitted ---a) Address proof of transferee should be same as installation
address
b) Photo I.D proof of the transferee c) Self attested passport size photograph of transferee
d) Undertaking in Annex – III e) Last paid bill copy
2. In case of change of Company’s name itself :--
I Incorporation certificate mentioning the change of name of the company issued by Registrar .
of Companies shall be submitted by the transferer.
II Current Trade License in the name of new company, if any , may also to be submitted.
III. Power of attorney / Authorization letter of authorized signatories.
3. In case of transfer from Company to other Company :--
I. Consent letters in letter head from both the Companies mentioning the reason of transfer
II Current Trade license and Address proof of the second Company shall be taken
III Power of attorney / Authorization letter of authorized signatories
 1. UNDERTAKINGFOR TRANSFEROFNAMEINCASEOFDEATH (ANNEXURE -1)
( within blood relation )
Sri / Smt. ----------------------------------------- son/daughter/wife/husband of late -------------------------
---------------------------- aged --------------- by faith ------------------ by occupation -------------------------
at present residing at ---------------------------------------------------------------- do hereby solemnly affirm
and declare as follows :--
That Late ------------------------------------------------- was the subscriber of Tel. No. ------------------------
and he / she died on --------------------------------- leaving behind him / her and others as legal heir/ heirs.
That intend to get Tel No. ------------------------------------- transferred to my personal name and account.
That other legal heir/heirs have given consent to the above proposal.
That henceforth I shall be liable for the above phone along with dues, if any. I do here by indemnify to
the BSNL against counter claim for the telephone in future.
That the above statements are true to the best of my knowledge and belief.

Dated at ------------------- -------------------------------------------------

Dt.------------------------- Signature of the Transferee

2. UNDERTAKINGFORGENERALTRANSFEROFNAME ( ANNEXURE – II )
( within blood relation )
Sri / Smt. ----------------------------------------- son/daughter/wife/husband of Sri/Smt.-------------------
---------------------------- aged --------------- by faith ------------------ by occupation -------------------------
at present residing at --------------------------------------------------------------- do hereby solemnly affirm
and declare as follows :--
That I am the holder of Tel. No. ----------------------------- that I intend to transfer my said telephone to
my son /daughter/other Sri/Smt. ------------------------------------------------------------------ on good faith.

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Dated at --------------------------- Signature of the transferer

Sri / Smt. ----------------------------------------- son/daughter/wife/husband of Sri/Smt.--------------------

---------------------------- aged --------------- by faith ------------------ by occupation -------------------------
at present residing at ---------------------------------------------------------------- do hereby solemnly affirm
and declare as follows :--
That my father/brother/other as above likes to transfer his/her telephone to my personal name and
account and I myself as transferee accept the proposal.
That henceforth I shall be liable for the above phone along with dues, if any.
That I shall abide by the rules and regulations of the Department of Calcutta Telephones.
That the above statements are true to the best of my knowledge and belief.

Dated at ------------------ -----------------------------------------------------------

Dt. ---------------------- Signature of the Transferee
3. UNDERTAKING UNDER CATEGORY OF THIRD PARTY TRANSFER ( ANNEXURE – III )
( no blood relation )
Sri / Smt. ----------------------------------------- son/daughter/wife/husband of Sri/Smt.----------------------
---------------------------- aged --------------- by faith ------------------ by occupation ----------------------------
at present residing at ----------------------------------------------------------- do hereby solemnly affirm
and declare as follows :--
That Sri / Smt./ M/s ---------------------------------------------------------------is/ was the holder of the Tel. No.
--------------------but the service is not required by the original user and I would like to use this line..
That I am using and intend to get the Tel No. ------------------------------- transferred to my personal name.
That in future if any person claims this telephone, then to verify the legality, the existing telephone
be deemed to have been surrendered .
That I agree to pay all dues till the last day of usage.
That I shall abide by the rules and regulations of the Department of Calcutta Telephones, BSNL.
That henceforth I shall be liable for the above phone along with dues if any. I do here by indemnify
to the Calcutta Telephones against counter claim for the telephone in future.
That I shall not claim the refund of original security deposit in future on surrender of telephone .

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Signature of the transferer (if available) Signature of the transferee
Date ------------------------Seal ( for company / firm ) Date ----------------------Seal (for company/ firm )