EmailMe Form - Streamyx Registration Form

Type of Application *
New
Upgrade
Package *
Name of Applicant
(as per NRIC) *
NRIC/Old IC *
Passport No
(For non-Malaysian Citizens)
Date of Birth *
DD / MM / YYYY
Email *
Gender *
Male
Female
Preferred Access Login
(In event of all three preferred access login is unavailable, we will contact you for other alternative)
Preferred Access Login ID 1 *
(Minimum 3, Maximum 8 characters)
Preferred Access Login ID 2 *
(Minimum 3, Maximum 8 characters)
Preferred Access Login ID 3 *
(Minimum 3, Maximum 8 characters)
Preferred Email Login
(In event of all three preferred email login is unavailable, we will contact you for other alternative)
Preferred Email Login 1 *
(Minimum 3, Maximum 8 characters)
(example: xxx@streamyx.com)
Preferred Email Login 2 *
(Minimum 3, Maximum 8 characters)
(example: xxx@streamyx.com)
Preferred Email Login 3 *
(Minimum 3, Maximum 8 characters)
(example: xxx@streamyx.com)
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