| 1.0 Application Packages |
| * Nationality |
|
| * Type of Package |
|
| * U Mobile Package |
|
| Upfront Payment |
RM |
| 2.0 Application Details |
| * Applicant Name |
* as per NRIC / Mykad / Passport |
| * ID Type |
|
| * NRIC (New) |
E.g. 830219431234 |
| ID No |
|
| Birthday |
|
| * Country |
|
| * Registered Address |
|
| * City |
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| * Postcode |
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| * State |
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| * Email Address |
|
| * Mobile No. |
|
| 3.0 Additional Information |
| * Type of Modem |
|
| 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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