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Registration

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Fibre Internet Package: *Please fill the required field.

New IC No: *Please fill the required field.

Applicant Name: *Please fill the required field.

Date Of Birth: *Please fill the required field.

Contact No: *Please fill the required field.

Email: *Please fill the required field.

Note: Strictly enter only customer's email for billing purposes, e-bill will be sent to this email address.

Are You Existing Account At the Same Premise? *

Yes

Please fill the required field.

Property Type: *Please fill the required field.

Installation Address:

Street Address *Please fill the required field.

Street Address Line 2

City *Please fill the required field.

Postal / Zip Code *Please fill the required field.

State / Province / Region *Please fill the required field.

Check here if the permanent address same as installation address.

Permanent Address:

Street Address

Street Address Line 2

City

Postal / Zip Code

State / Province / Region

Check here if the billing address same as installation address.

Billing Address:

Street Address

Street Address Line 2

City

Postal / Zip Code

State / Province / Region

Installation date and time:

Preferred Installation Date: *Please fill the required field.

Preferred Installation Time: *Please fill the required field.

Remark:

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