Student Broadband Package Application Form

Student Information
Name Registration # Mobile # Home Phone # Email Address Customer Type NIC # Mr Syed Fawad ali shah GCMS/P/OS/II-S/11-6780 03139277858 & 91590343 syedfawadalishahs@yahoo.com Student 17301-1309353-1

& @Hotmail & @Gmail

Package Information
Broadband Phone # City Package 91590343 Peshawar 1 MB ps

University Information
University Name Department University City University Contact Number Date Of Enrolment Date of Completion Govt College of Management Sciences Peshawar D.com 1st Peshawar 919212926 19-MAY-2012 19-MAY-2012

University Verification
Name of Registrar/Dean/Principal/faculty Signature & Stamp ............................................. .............................................

li shah a d a w a f d e Signature of Student S ............................................. y

For PTCL Use only
Login Choice 1 Login Choice 2 Login Choice 3 Syedfawadalishahs ............................... ...............................