REGISTRATION FORM | F4 INTERNET SOLUTIONS

DATE OF CONNECTION *

SERIAL NO:

Passport Size Photograph *

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MOBILE NUMBER *

OTHERS NUMBER

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MALE

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FEMALE

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SHARED

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DEDICATED

1.SUBSCRIBER NAME *(INDIVIDUAL/ORGANIZATION)IN BLOCK LETTER

2.AUTHORIZED PERSON'S NAMEAPPLICABLE FOR ORGANIZATION

3.NATIONAL ID NO.FRONT *

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OR PASSPORT NO.

3.NATIONAL ID NO. BACK *

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OR PASSPORT NO.

4.DATE OF BIRTH *

5.PERMANET ADDRESS

6.PRESENT ADDRESS

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PACKAGE 1

5Mbps

PACKAGE 2

8Mbps

PACKAGE 3

10Mbps

PACKAGE 4

20Mbps

BILLING ADDRESS

PERMANENT ADDRESS

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PRESENT ADDRESS

11.RATE : TAKA

BILL DATE

12.Email Address *

I DO HEREBY DECLARE THAT THE INFORMATION AND DATE GIVEN ABOVE ARE CORRECT. IN CASE OF ANY FALSE INFORMATION, I SHALL BE LIABLE TO APPROPRIATE LEGAL ACTION AND I SHALL ABIDE ALL TERMS AND CINDITIONS OF INTERNET USE AS PER BTRC AND LAWS OF THE COUNTRY. I ALSO AGREE THAT I ALSO PAY THE MONTHLY BILL WITHIN 10th OF THE RUNNING MONTH & NOT DISCONTINUE WITHIN THREE (3) MONTHS OF ACTIVATION. *

Yes, I agree with the privacy policy and terms and conditions.

SIGNATURE *

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ORGANIZATION SEAL SIGNATURE

DATE *

APPLICANT'S *

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USER SIGNATURE