Student Package Registration Form
Customer Info         
         

PTCL LANDLINE CUSTOMER ? :

  
Yes No     
 *   (Existing PTCL Landline Customer?)
TITLE :
 
Mr Mrs Ms
    
FIRST NAME:
  
*  
LAST NAME:
 
*  
MOBILE PHONE:
 
 - 
   
EMAIL ADDRESS:
 
*  
CUSTOMER TYPE :
 
   
   
   

(Option 1)

 
   
STUDENT NIC #:
 
*  

(If Student under age of 18 and NIC # has not been issued than option 2 applies)

(Option 2)

  
   
STUDENT'S "Form B" #:
 
*  
EITHER OF PARETN'S NIC #:
 
*  

         
CITY/TOWN :
 
*  
PHONE NUMBER:
 
* (Phone Number on which
Broadband is required)
         

ADDRESS :

 
*

(Address Where Broadband
connection is required)
 
        
PREFERRED LOGIN ID : 
    (Your Preffered Login ID )
PACKAGE OPTIONS :
 
PACKAGE 1 : 1MB          
 *  
         

Institute Info        
         
INSTITUE CITY/TOWN :
 
* (City of Institune, College , University)
EDUCATIONAL ISTITUTE :
 
DEPARTMENT :
  * (Department Of Study)
INSTITUTE CONTACT NUMBER:
 
* (School , College , Institute , University #)
STUDENT REGISTRATION #:
    (School , College , Institute Registration#r)
SDATE OF ENROLLMENT:
 
  (Date of Enrollment)
EXPECTED DATE OF COMPLETION:
 
  (Expected date of Completion)
 
All fields marked with asterisks “*” are mandatory and without filling those fields form will not be accepted