EmailMe Form - unifi / Streamyx Application eForm

Section 1: Service details

Type of Application (Jenis Permohonan): *

New (Pendaftaran Baru)

Upgrade from Streamyx (Naiktaraf dari Streamyx)

unifi Register Interest, for port full or no coverage case

Package (Pakej): *

All prices are exclusive of 6% SST.
Semua harga tidak termasuk 6% SST.

For other packages not mentioned, please contact admin.
(Untuk pakej2 lain yang tidak tertera, sila hubungi admin.)

Preferred Login ID (Option 1):

Streamyx fixed 8 characters
unifi Min 5 characters Max 20 characters

Preferred Login ID (Option 2):

Streamyx fixed 8 characters
unifi Min 5 characters Max 20 characters

Preferred Installation Day (Tarikh Pemasangan Pilihan):

Section 2: Existing Streamyx/TM Homeline Details

(For existing Streamyx/TM Homeline customer only)

TM Homeline No:

Nombor telefon rumah/Streamyx sekarang

Existing Package:

Existing Package Owner Name:

Nama pemilik akaun telefon rumah/Streamyx sekarang

Section 3: Applicant Details

Maklumat Pemohon

Full Name [as per IC/Passport]: *

Nama Penuh Seperti Dalam IC

IC/Passport No: *

Malaysian Citizen, please upload a copy of IC below
Non-Malaysian, please upload a copy of passport below

Property Type:

Landed

High-Rise (5-storey and more)

Installation Address: *

Alamat pemasangan

Contact No: *

Nombor telefon pemohon

Email Address: *

Section 4: Supporting Documents

Attachment *

Please upload your clear copy of IC (both sides) or passport.
Sila lampirkan gambar/salinan IC depan belakang yang jelas

Attachment

Please upload your color copy of IC (both sides) or passport.
Sila lampirkan gambar/salinan IC depan belakang yang berwarna

Section 5: Misc

Remarks:

Add on:
CG ID:
LYN ID:
Bank Account No, For Rebate Purpose:

Where did you know about our registration service:
(Dari mana anda tahu mengenai servis pendaftaran kami): *