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NIC MAIL CREATION FORM- Pdf

The document is an application form for dial-up internet access or email account from the National Informatics Centre, Government of India. It requires personal information such as name, date of birth, designation, and contact details, and must be signed by both the applicant and a competent authority. The form also includes sections for office use regarding billing and user ID creation.

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chowdhary subhash
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89 views

NIC MAIL CREATION FORM- Pdf

The document is an application form for dial-up internet access or email account from the National Informatics Centre, Government of India. It requires personal information such as name, date of birth, designation, and contact details, and must be signed by both the applicant and a competent authority. The form also includes sections for office use regarding billing and user ID creation.

Uploaded by

chowdhary subhash
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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National Informatics Centre Internet services Internal Documents

Government of India
Department of Information Technology, MCIT
NATIONAL INFORMATICS CENTRE

APPLICATION FOR DIALUP (ISDN/ PSTN) INTERNET ACCESS ( ) / E-MAIL ACCOUNT ( )


(please tick (v) the required services and read the instructions given in the reverse of this page; the completed application form,
duly signed by the concerned project coordinator /Hod of the concerned NIC cell, should be submitted to support center at
“INOC, a4b2 bay, a-block C.G.O. Complex”). Please Use Capital Letter.
1) NAME*:________________________________________________________________________
(DR. /MR. /MS. FIRST NAME MIDDLE NAME SURNAME)
2) DATE OF BIRTH (DOB)*:_____/____/__________
3) DESIGNATION*:________________________________
4) REGIMENTAL/IRLA/SERVICE NUMBER:______________________MIN./DEPT./ORG*: MHA (BSF)
5) ADDRESS OF CORORRESPONDENCE
______________________________________________________________________________
CITY:_______________________STATE:________________________PIN CODE:_____________
6) TELEPHONE NUMBER :(0)*_____________________________(R)_________________________
7) MOBILE*:________________________________________
8) PREFERRED EMAIL ID**:
A) [email protected].
B)[email protected]
9) ALTERNATE E-MAIL ADDRESS, IF ANY, FOR CORRESPONDENCE:
______________________________________________________________________________
10) DATE OF RETIREMENT (DOR) (DD/MM/YYYY)*:________________________________________
This is to declare that I have read the terms and conditions and I agree to abide by them.
* Entries are mandatory and need to be filled.

Signature of Competent Signature of the Applicant


Authority of the Department With date and seal
With date and seal

Account category:
Free ( )/ Paid ( )
If free, on what basis: _________________________________________________________
If paid, project no.:____________________________________________________________

Signature of NIC
Coordinator/HOD with date
and seal
Name & designation:-_________________
E-mail and tel.-_____________________________________

FOR OFFICE USE


billing division (RR section):
file number:
payment processed: yes/ no signature
user id creation:
Assigned login id:_____________________________domain:________________
Remarks (BO/PO):_______________________________

signature of INOC in charge

signature of the operator

Name& Desig.:______________________________

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