Application Form for ordinary Membership

APPLICATION FORM FOR ORDINARY MEMBERSHIP

Name of Company *

Office Address *

Tel *

Fax

e-mail *

Address in Delhi (if any)

Tel

Fax

e-mail

Connection type

Name *

Designation *

Tel.(Dir.) *

e-mail *

We are engaged in the business of providing Internet services to subscribers and posses a valid Internet Service Provider Licence (No. and dated ) issued by the Department of Telecommunications ,Government Of India

We are engaged in the business of providing content delivery network services to subscribers and posses a valid Autonomous System

AS Number *

PAN Number

We nominate Mr/Ms *

Designation *

Dated *

As our representative in NIXI. All communication to him/her may kindly be sent at

We nominate Mr/Ms *

Designation *

Address *

Tel.(off) *

(Res. Tel)

Fax

e-mail *

NOTE : Please attach the copy of ISP license issued by Department of Telecommunications ,Government of India and copy of PAN card.

NOTE: Please attach the copy of WHOIS details for verification of AS number and copy of PAN card

* Copy of WHOIS details for verification of AS Number

Copy of PAN Card

Company GST

Upload Copy of ISP License

Connection Aggrement [ Note: Please download NIXI Connection Agreement - ISP/Non ISP and upload below duly signed copy.]

Copy of Agreement *

Auto Generated Application No

Referral Code

Membership fee of Rs.1000 + applicable taxes will be demanded once the peering is established.

We agree to abide by the Memorandum and Articles of Association and the Rules of the company. We agree to pay Rs.1000 + 18% GST toward the annual membership once peering is established.

APPLICATION FORM FOR ORDINARY MEMBERSHIP

Our ISP Member