Requisition Form: Name (As Per Ic/Mykad) Non-Malaysian

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Requisition Form

Requirements and instructions


Please write in capital letters. Tick or delete where applicable.
A. Customer Details
Name (as per IC/MyKad) Mr. Mrs. Mdm. Others (e.g. Dr. / Dato, etc.) Non-Malaysian
NRIC / MyKad No. - - Old IC / Passport
REDtone Mobile No. REDtone Account No.
B. Services Required
Call Divert ( RM 3/month ) 3GB ( RM60/month )
Caller Line ID Restriction ( CLIR ) ( RM10/month ) 1GB ( RM25/month )
International Direct Dial ( IDD ) 500MB ( RM15/month )
International Roaming ( RM300 Deposit ) 100MB ( RM5/monht )
Printed Itemised Bill ( RM5/month ) 3GB+ ( RM65/month )
Blackberry Service ( RM25/month ) 1GB+ ( RM30/month )
Others _____________________________________ No Data
C. Others Services / Facilities
Bill Reprinting Months(s) Required _____________________
Change of Address
Postcode
Change of:
Contact No. (H) (O) - Ext: _____________
Email _________________________________________ Fax -
Change of Mobile No ( Old ) ( New )
Change of Package ( Old ) __________________________________ ( New ) ________________________________
Temporary Disconnection __________________________________ Reconnection
Note: Line will be permanently terminated after 50days of Temprorary Disconection. Note: Can only be done within 50days of Temprorary Disconnection
SIM Card Replacement SIM Serial No.
(Affix SIM Card Sticker)
Reason for Replacement _________________________________
D. Customer Declaration
Company Stamp
Authorised Signatory Signature
Date - -
d d m m y y y y
E. For Office Use Only
Processed By: Approval by:
Date - - Date - -
I declare that all the above information is true and complete and I would like to have the selected service(s)
rendered. I have read, understood and agree to be bound by the Term & Conditions of the Customer
Agreement. I also to be severally liable for all fees and charges.

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