Internet Connectivity Declaration Form
Full Name
Employee/Student ID
Department / Course
Contact Number
Home Address
Internet Service Provider
Type of Internet Connection
Wired (e.g. DSL, Fiber)
Wireless (e.g. 4G/5G)
Mobile Data
Other
Approximate Internet Speed (Mbps)
Any existing issues with connectivity?
Alternative source of internet access (if any)
I hereby declare that the information provided above is true and accurate to the best of my knowledge.
Date
Signature (Type your name)