| 1.0 Application Packages |
| * Type of Package |
|
| * P1 Package |
|
| * Type Of Modem |
|
| 2.0 Applicant Details |
| * Applicant Name |
* as per NRIC / Passport |
| Company Name |
|
| Company Registration No. |
|
| Type Of Business |
Sdn Bhd
Bhd
Partnership
Sole Proprietor |
| * ID Type |
|
| * NRIC (New) |
E.g. 830219431234 |
| ID No. |
For Passport, Military and Police ID No. |
| * Email |
|
| * Mobile No. |
|
| Contact No. |
E.g. 0392832020 |
| * Installation Address |
|
| * Town |
|
| * Postcode |
|
| * State |
|
| 3.0 Additional Information |
| * Billing Method |
By Email
By Post *Charges RM5 in Bill |
| * Installation |
|
| Remarks |
|
| 4.0 Supporting Documents |
| 1. |
* The file size is limit to 1Mb. |
| 2. |
|
| 3. |
|
| 5.0 Verification Purpose |
| * Security Code: |

Enter the characters as seen on the image above (case sensitive):
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