Nomination Form [For Individual applicants Other than Joint Applicants] I hereby nominate the person mentioned below who shall, in the event of my death, be entitled to get the telephone/ registration transferred through this form to his /her name or be entitled to be paid the amount of registration/security deposit for the telephone so registered in my name, to the exclusion of all other persons. (i) Name of the Nominee (In Block Letters) (ii) Relationship with applicant (ii) Full Address of the nominee (In Block Letters) (iv) In case nominee is a minor, please indicate Date of Birth of minor Signature of the Nominee Signature of Applicant Name Name Full Address Full Address:________________________ _________________________ _ Witness 1 Signature Name Complete Address 2. Signature Name Complete Address
