This document is an application form for residential broadband internet access service from Allo Technology Sdn. Bhd. It includes information about the applicant such as name, NRIC number, address, and contact details. The applicant is applying for a 24 month contract with a 100Mbps package for RM99 per month. The form also lists the required documents, terms and conditions, and sections for signatures and acknowledgment.
This document is an application form for residential broadband internet access service from Allo Technology Sdn. Bhd. It includes information about the applicant such as name, NRIC number, address, and contact details. The applicant is applying for a 24 month contract with a 100Mbps package for RM99 per month. The form also lists the required documents, terms and conditions, and sections for signatures and acknowledgment.
This document is an application form for residential broadband internet access service from Allo Technology Sdn. Bhd. It includes information about the applicant such as name, NRIC number, address, and contact details. The applicant is applying for a 24 month contract with a 100Mbps package for RM99 per month. The form also lists the required documents, terms and conditions, and sections for signatures and acknowledgment.
This document is an application form for residential broadband internet access service from Allo Technology Sdn. Bhd. It includes information about the applicant such as name, NRIC number, address, and contact details. The applicant is applying for a 24 month contract with a 100Mbps package for RM99 per month. The form also lists the required documents, terms and conditions, and sections for signatures and acknowledgment.
(501001-A) (formerly known as Setia Haruman Technology Sdn Bhd) Cyberview Garden Villas, Persiaran Multimedia, Cyber 7 63000 Cyberjaya, Selangor Darul Ehsan Tel: +603-88005222 Fax: +603-88005221 E-mail: customerservice@allo.my Website: www.citybroadband.my BROADBAND INTERNET ACCESS SERVICE APPLICATION FORM RESIDENTIAL PACKAGE Please write in CAPITAL LETTERS and tick (√) where required. APPLICATION : 1 New Upgrade / Downgrade Relocation APPLICANT'S INFORMATION Full Name SIVA NAIDU A/L PERUMAL NAIDU NRIC/Passport No. 8 0 0 2 1 4 0 8 6 1 3 3 Contact No. 0 1 2 - 4 6 1 9 5 2 9 (Primary) - (Secondary) Citizenship MALAYSIAN E-mail cva142@gmail.com
INSTALLATION ADDRESS Unit No. 4 J - - Level Block LEBUH RAPAT BARU 18A MEDAN LAPANGAN SURIA City/State IPOH, PERAK Postcode 3 1 3 5 0
SERVICE DETAILS 1 Subscription/Contract Period : 12 months (one time charge of RM300 is applicable) 1 24 months 2 Required For Service (RFS) Date : - - Billing Cycle: √ Monthly Notes : 1. Standard contract period is 24 months unless otherwise stated. 2. Required For Service (RFS) date is subject to the availability of required infrastructure and/or equipment. Remark : _____________________________ 3. Early termination will subject to RM500 penalty.
PACKAGE DETAILS 1. City Broadband Residential (Best Effort Bandwith) ADVANCE PAYMENT 50Mbps RM79 (Payable to Allo Technology Sdn Bhd)
1 100Mbps RM99 1) 12 Months Contract :
500Mbps RM139 One Time Charge: RM300
1Gbps RM199 * All prices quoted are subject to 6% SST 2) 24 Months Contract :
2. Voice (Home) Deposit : RM0 1 Malaysian
Yes No : RM300 Non-Malaysian
Remark : 1 month fee - RM20
Call rates at RM0.08/min TOTAL : __________________ *Deposit is refundable
DOCUMENTS AND DECLARATION
Documents Required : √ Photocopy of NRIC (both sides) or passport (Non-Malaysian) Declaration : 1 I hereby consent to the collection, use, disclosure of my personal information in accordance with the Privacy Policy availabe on www.citybroadband.my. 1 I hereby declare that the above information, documents and any appendices attached are true and valid. I have read and understood the contents of this form and agreed to be bound by Terms & Conditions as stated on the next page of this form which accompany the subscription of product(s) and/or service(s). 1 By signing this document, I agree and accept the Terms & Conditions stipulated herein. I declare that the information provided by me is true and valid. Concentric Media Sdn Bhd reserve the rights to refuse my application at any given time without any refund or whatever monies held by Concentric Media Sdn Bhd should any of the above information is found to be incorrect. If the service is offered to me, I declare to be bound by the Terms & Conditions of the service herein. APPLICATION ACKNOWLEDGEMENT FOR OFFICE USE ONLY Technical: Date: Sales: Date: Verified By: Date: Finance: 1st Billing Date: Activation Date: Applicant's Signature City Broadband's Acknowledgement Remark: Date: 13.8.2023 Date:
