DJB RMS PORTAL

Application Form for Disconnection / Reopening

KNO *

Application Details:

Application For :

Disconnection

Reopening

Type of Disconnection :

Temporary Disconnection

Permanent Disconnection

Reason For Disconnecting/Reopening:

Contact Details:

Preferred Contact Type: :

LandLine

Mobile

LandLine Number

Email Id

Mobile Number *

Documents To Be Attached (Max Size 1 MB) :

Proof Of Identity *

Document No *

PhotoCopy Of Proof Of Identity *

Photocopy of Last Paid Bill *

Ownership Document *

Profile Photo *

Signature *

Declaration

I hereby declare that all the information furnished by me is true to the best of my knowledge and if any discrepancies are found, I will be responsible for legal action.

Submitted By

Submitted By *

I accept all the terms and conditions specified above.

Application Type	ss
Application Ref No	ss
Date Of Submissions	ss

Application Form for Disconnection / Reopening

Application For :

Type of Disconnection :

Preferred Contact Type: :

Application Reciept