| 1.0 Application Packages |
| * Nationality |
|
| * Type of Package |
|
| * Celcom Package |
|
| Upfront Payment |
RM |
| Principle Mobile No. |
|
| Supplementary Mobile No. |
|
| 2.0 Application Details |
| * Applicant Name |
* as per NRIC / Mykad / Passport |
| * ID Type |
|
| * NRIC (New) |
E.g. 830219431234 |
| ID No / NRIC (Old) |
|
| Birthday |
|
| * Country |
|
| * Registered Address |
|
| * Town |
|
| * Postcode |
|
| * State |
|
| * Email Address |
|
| * Mobile No. |
|
| Contact No. |
|
| * Mother Name |
Full Name |
| 3.0 Monthly Bill Settlement Preference |
| * Language |
|
| * Bill Format |
|
| 4.0 Reference |
| * Reference Name |
|
| * Reference Mobile No. |
|
| * Relationship |
|
| 5.0 Additional Information |
| * Type of Modem |
|
| Remarks |
|
| 6.0 Verification Purpose |
| * Security Code: |
Enter the characters as seen on the image above (case sensitive):
|
