(A) Licensee Details

LAUNCH / Revision
Operator Name Circle (Service Service (GSM /
Area) CDMA / LTE) / Correction /
Withdrawal
Record ID
Tariff Summary No.
 (B) General Details of Product

Unique ID's of the Date of LAUNCH / Time duration of Time duration of

Revision / REGULAR / PROMOTIONAL / PROMOTIONAL /
Name of the Plans for which Date of reporting
TopUp Voucher exclusively (dd-MMM-yyyy) Correction / PROMOTIONAL limited period limited period
Withdrawal (dd- Offer offer starts from offer valid till (dd-
applicable MMM-yyyy) (dd-MMM-yyyy) MMM-yyyy)
 (C) One Time Charges (E) Miscellaneous

Mode of Activation
/ Recharge Whether details of
MRP (Including this service have
Eligibility Monetory Value (in Terms and (Website / App TSP website link of the
Conditions, if any Processing Fee & Rs.) Conditions, if any only / paper / been uploaded on Plan
GST) the website
USSD / 3rd party (Yes/No)
Wallet etc)
 Delay in Submission

Condition for If Delayed

Any other Reason for Delay
termination of declarations Submission, enter
Product if any 'Yes', else 'No'