Licensee Name *

Licensee Type * Select TSP - Telecome Service Provider ISP - Internet Service Provider Infrastructure Provider

Mention Type * Select Licence Type A/B/C Licence Type E, G, Wireless Service Provider

Licensee GSTIN *

Licensee PAN *

Licensee TAN *

DOT Registration Date *

DOT Registration Expiry Date *

Authorized Person Name *

Authorized Person Designation *

Authorized Person ID proof Type * Select Aadhaar Voter ID Passport Driving License

Authorized Person ID proof No. *

Authorization letter from TSP ( authoring applicant to submit application on behalf of TSP) *

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Email * Email ID already exit. Please try another..

Mobile No *
Click on Send OTP button to verify your mobile number
Invalid Mobile Number

License Number *

License Expiry Date *

License Document *

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Officer Level Select Division Sub Division Section

Division Name Select

Sub Division Name Select

Section Name Select

Designation

Applicant name *

District * Select Thiruvananthapuram Kollam Pathanamthitta Alappuzha Kottayam Idukki Ernakulam Thrissur Palakkad Malappuram Wayanad Kozhikode Kannur Kasaragod

Local Body Type * Select Corporation Municipality Grama Panchayath District Panchayath Block Panchayath

Local Body Name * ---Select---

Email *
Email ID already exit. Please try another..

Mobile Number *
Click on Send OTP button to verify your mobile number
Invalid Mobile Number..

Aadhaar Number * Invalid Aadhaar Number

Aadhaar Upload *

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Voter ID card/Passport/Driving License *

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Building Tax Paid receipt

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Sanctioned Building Plan

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Land Tax (Optional If buiding plan is not available)

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Ownership Certificate ( Optional)

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