form

“My Airtel” Access Application Form

Chief Customer Service Officer
Bharti Airtel Limited,
(Circle Address)
________________


Dear Sir,

I/We hereby apply for “My Airtel” access and accordingly E-Bill, etc. facility be made available to me/us for my Airtel number ______________ having unique Account Identification number _________ and my preferred login Id___________( If applicable – Applicable for New Registration)

I/We hereby instruct and authorize the Bharti Airtel Ltd. to email “My Airtel” access Password to enable me/us to use ‘My Airtel’ Services at my email ID: ________________________. I/We affirm that I/we am/are the subscriber of the above number and shall only use the said facility till I/We continue to be the subscriber of the above number.

I/We hereby agree that the risk/ consequences of non-receipt and / or disclosure of the ‘Password’ to an unauthorized third party shall be fully borne by me/us. I/We further, confirm that I/We shall always keep Bharti Airtel Ltd indemnified and it shall not be held responsible in any way for any losses that may be suffered by me/us or any one else, as a result of such non-receipt or disclosure of the Password to an unauthorized person.

I/We hereby undertake to be governed and abide by all terms for the use of the said services. I/We hereby authorize and instruct the Bharti Airtel Ltd. to act on all my/our requests received through the email or any other mode - including but not limited to the change of password, security codes, sending bills from my/our account(s) with the Bharti Airtel Ltd., etc. I/We also undertake not to raise any objections whatsoever in the event Bharti Airtel Ltd. withdraws this facility without notice and/or without assigning any reason whatsoever.

I warrant that all the information provided in this application is identical to the one provided by me/us in CAF/ SEF furnished by me/us. The information provided by me/us are true, correct, accurate and complete in all respects.

Signature of Subscriber ____________________
Name of Subscriber_____________________
Address ___________________
Phone number __________________
(For which My Airtel’ Services has been applied)
Date _________________

Pl. note :
For company accounts, the form must be accompanied by a request on the company letter head, duly signed by the authorized signatory
Self Attested Photo ID plus signature proof required