Internet Broadband Please enable JavaScript in your browser to complete this form.Fields marked with an * are required Please fill in your details below with all the required documents and correct information. Contact 1600 for further information.Please ensure that the fields marked in asterisk(*) are filled,ticked or chosen. Applicant's Address (Address where broadband is to be provisioned)Name *Select dzongkhag *ZhemgangSamdrup JongkharPemagatshelMongarTrashigangTrashi YangtsheLhuentseBumthang TrongsaSamtseTsirangWangdue PhodrangGasaPunakhaDagana ChukhaSarpangGelephuHaa Thimphu ParoAddress *Telephone NumberMobile Number *Your Email *Billing Address (if different from applicant’s address)NameAddressTelephone NumberMobile NumberYour EmailPermanent AddressCID *Village *Gewog *dzongkhag *ZhemgangSamdrup JongkharPemagatshelMongarTrashigangTrashi YangtsheLhuentseBumthang TrongsaSamtseTsirangWangdue PhodrangGasaPunakhaDagana ChukhaSarpangGelephuHaa Thimphu ParoPlease tick 'dnet' if you are applying for prepaid & 'post' for post paid dnetpostPrepaid? Choose the type of package399, 8,192MB 1MONTH599, 15,360MB 1MONTH1099, 32,768MB 1MONTH1499, 46,080MB 1MONTH1999, 63,488MB 1MONTH2499, 81,920MB 1MONTHPostpaid? Choose the type of package.499, 9,216MB 1 MONTH799, 19,456MB 1 MONTH1199, 33,792MB 1 MONTH1599, 46,080MB 1 MONTH2999, 1,02,400MB 1 MONTHModem1. BTN 2050 for ADSL2+ with RJ45 WANA PORT with 1 year warranty 2. A onetime payment of BTN 5,000, or installment payment of BTN 500 per month, for Fiber Modem (FTTH) with 1 year warranty Note1. New Connection charge of BTN 100 will apply for all broadband services, except for FTHH and FTTB. 2. The Modem warranty does not cover damages arising out of physical mishandling, power problems and lightning3. Installation charge of BTN 250 will apply if the modem is not bought from BT. 4. Installation charge of BTN 1,375 will apply if the broadband service is provided over FTTB network. Documents Required (Please bring along a photocopy of one of the following relevant documents:) Citizenship Identity Card/Trade License or Authorization Letter from Office:For Non-National: Please submit a surety letter from your agency in Bhutan. Note for Postpaid Broadband Application: Surety form has to be filled in separately by a guarantor of the payment/dues. [Note: For office connection, a formal letter applying for postpaid will be required which will be taken as the surety.]Documents Required(Please bring along a photocopy of one of the following relevant documents:) Citizenship Identity Card/Trade License or Authorization Letter from Office: For Non-National: Please submit a surety letter from your agency in Bhutan. Note for Postpaid Broadband Application: Surety form has to be filled in separately by a guarantor of the payment/dues. [Note: For office connection, a formal letter applying for postpaid will be required which will be taken as the surety]I hereby declare that I have read and fully understood the terms and conditions (mentioned overleaf) and have accepted the same for the subscription of broadband Internet service. I also hereby declare that the information provided by me is correct to the best of my knowledge and will adhere to the terms and conditions and fully bear the consequences deemed appropriate by the service provider in case of non- compliance to any terms and conditions. I HAVE SIGNED BELOW ONLY AFTER HAVING RECEIVED WELCOME PACK FOR BROADBAND INTERNET THAT CONTAINS INFORMATION ESSENTIAL TO HELP ME PROPERLY USE, SECURE, CONTROL AND MANAGE MY BROADBAND ACCOUNT.Singed Broadband application form * Click or drag a file to this area to upload. I AGREESubmit Get in Touch with us (+975) 343434 Toll Free: 1600 Address: Drophen Lam 2/28, Chubachu Thimphu, Bhutan