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Customer Undertaking for Additional Static-IP

Customer Details:
Customer Name:

Address:

Account Details:
Service id (User id):___________ BAN: _____________ Plan Name: ____________
Number of computers in customer home/ organization: ___
Static IP pool allotted: __________
WAN device type*: ____________ WAN Device Make and Model:_______________
WAN device MAC address: _______________ WAN IP details: _______________
Additional Static -IP Details:

Reason for usage of Static-IP: Web Hosting / Mail / FTP / Others ____________________ (please specify)
Allotted Static-IP pool: _________________ ___________ (to be filled by SAM after Static-IP allocation)

Equipment Details: (to be made available for all equipment on which Static IP is being used)
Sr.no Device type Device Make
and Model
Device MAC
address
Assigned IP
address
1
2
Device Type: E.g. Router, Firewall, Server, L3 Switch,etc. * If Static-IP is required on customers device (e.g. Router, Firewall
etc) then please share its WAN port MAC Address. Static-IP can be provided only on layer 3 device.











< Customer Name/Visit number> < Date> Page 2


a. LAN diagram of customers network where Static-IP implementation is required (please
draw below):




Customer Declaration:


< Customer Name/Visit number> < Date> Page 3


1. Internet Telephony: Internet telephony means a service to process and carry voice signals
offered through public internet by use of Personal computers(PC) or IP based customer Premise
equipment (CPE) connecting the following:
a. PC to PC ; within or outside India
b. PC /a device / adapter conforming to standards of International agencies like ITU, IETF
etc; in India to PSTN/PLMN abroad
c. Any device /adapter conforming to standards of International agencies like ITU,IETF etc;
connected to ISP node with static IP address to similar device/adapter; within or outside
India
2. The internet telephony described in condition 1. Above is only permitted
3. Addressing scheme for Internet telephony shall only conform to IP addressing scheme of
Internet Assigned Numbers Authority (IANA) exclusive of National Numbering Scheme/plan
applicable to Basic/Cellular Telephone service. Translation of E.164 number/private number to
IP address allotted to any device and vice versa, to show compliance with IANA numbering
scheme is not permitted
4. Customer acknowledges that VoIP will not be used in any form other than what is permissible
under the Internet services license.
5. Customer acknowledges that the IP given will not be used for terminating VoIP calls on domestic
PSTN network.


Name:
______________________________ ______________________________
Service Assurance Manager Customer Name

Signatures:
______________________________ ______________________________
Service Assurance Manager Customer Signature
(Company stamp for SMB customer)