Skip to content
Email Login
Email
Home
Shop
My account
Menu Toggle
Orders
Checkout
Cart
Wishlist
Form
Downlod
Menu Toggle
Software
Account
Menu Toggle
Register
Login
Broadband Apply
Contact
About
Main Menu
Aadhar Appointment
About
Account
AEPS
Broadband Apply
Cart
Checkout
Company Login
Contact
Downlod
Form
Login
Logout
Members
My account
Online
Password Reset
Register
Services
Shop
Software.
User
Wishlist
Customer Subscription Form For Broadband
Please enable JavaScript in your browser to complete this form.
1. Applicant`S Name
*
First
Middle
Last
2. Name Of Firm
3. Father`s/Husband Name
*
4. PAN NO
5. Gender
*
Male.
Female.
Other
6. Date Of Birth
*
MM
1
2
3
4
5
6
7
8
9
10
11
12
DD
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
YYYY
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
7. Existing Customer
*
Yes
No
8. Email
*
9. Phone
*
10. Marital Status
*
Married
Single
11. Proof of Identity
*
Driving Licence.
Passport.
Voter ID Card.
Aadhar Card.
Govt. ID Card
Any Other
12. Proof of Address
*
Driving Licence.
Passport.
Ration Card.
Aadhar Card.
Latest Tele/Electricity Bill
Any Other
13. Services/Plan /Package
*
10 Mbps Unlimited @ 647.82
20 Mbps Unlimited @ 707.82
50 Mbps Unlimited @ 1001.82
75 Mbps Unlimited @ 1178.82
100 Mbps Unlimited @ 1414.82
150 Mbps Unlimited @ 1643.82
20 Mbps 708 Unlimited X 6Month@ 4243
50 Mbps 1002 Unlimited X 6Month@ 6012
SME_2 Mbps @1532.82
SME_4 Mbps @ 2358.82
SME_5 Mbps @3066.82
SME_8 Mbps @4718.82
SME_10 Mbps @6842.82
FUP 10 Mbps@5GB/Day @589
FUP 10 Mbps@10GB/Day @1179
FUP 50 Mbps@500GB @766
FUP 100 Mbps@500GB @1061
FUP 150 Mbps@500GB @3539
FUP 200 Mbps@500GB @3775
If Installation Adress/Billing Address Same Please Tick
Choice 1
14. Permanent address
*
15. Installation Address / Billing Address
*
Landmark
*
Landmark
*
State
*
Bihar
State
*
Bihar
District
*
District
*
Muzaffarpur
Vaishali
Pin Code
*
PIN Code
*
844118
844122
844134
844114
15. Upload Photograph
*
16. Proof of Identity
*
17. Proof of Address
*
Declaration : I have read ,understood that the service(s) opted by me,as above,shall be provided in accordance with the terms and condition overleaf and as published in www.kkdigital.in and agreed to abide by them.i shall be solely responsible of all payments to words my subscription(s)
*
I Accept
Submit
