Celcom Application Form

Fields marked with an asterisk * are required

1.0 Application Packages
* Type of Package
* Celcom Package
Principle Mobile No.
Supplementary Mobile No.
2.0 Application Details
* Applicant Name	* as per NRIC / Mykad / Passport
* NRIC (New)	E.g. 830219431234
NRIC (Old)	Elder than 1978 must provide Old IC No
* Installation Address
* Town
* Postcode
* State
* Email Address
* Mobile No.
Contact No.
* Mother Name
3.0 Monthly Bill Settlement Preference
* Language	Bahasa Malaysia English
* Itemised Billing	Yes No
* Bill to	Home Office Other (Malaysian Address Only)
4.0 Reference
* Name
* Relationship
* Mobile No.
Contact No.
5.0 Additional Information
* Type of Modem
Remarks

This application form is provided in a secure environment and to help protect against fraud your current IP address (38.107.191.105) is being logged.

How to register:

Email, SMS or IM us the customer IC number(new and old) in order to check whether the customer is blacklisted.
If customer is not blacklisted and then we will fill up the celcom registration form for customer.
Customer need to provide customer's identity card (both sides) to us.
We will process the application once we receive the customer's document. Once the application is approve, we will send the modem to the you (about 3 working days).
Within 3 working days, customer is able to use Celcom Broadband once we pass the modem and sim card to the customer.

*** Celcom is only accept original of the customer documents.

*** Postage method is been take risk from the agent. We wont be responsible on it.

*** Upfront payment is 1 month of the package price and it will rebate to the customer's first month bill. Additional RM10 stamp duty fee will charge in first month bill.

PAYMENT METHOD

Name: NG MUN PHIN
Account No: 114281060992
3rd Party Email : sales@mybroadband4u.com
Contact No. : 012-6906695

PAYMENT METHOD

Name: NG MUN PHIN
Account No: 14091374354529
3rd Party Email : sales@mybroadband4u.com
Contact No. : 012-6906695