Application Form (Tel & Streamyx)

STREAMYX & TELEPHONE LINE APPLICATION

Applicant Name
IC / Co. Reg. No.		Old IC No.
House No		Building
Lot No		Street
Floor		Garden
Apartment No.		City
Postcode		State
Neighbour TM Fixed No
Contact Person
IC No.	................................	Mobile No.	.................................
Streamyx Package
Monthly Fee		SIB	Yes / No
Modem	with / without
Preferred - Login 1		Preferred Domain Name 1
- Login 2		Domain Name 2
- Login 3		Domain Name 3
Remark

Document Required:-
A) Personal Package

• 1 copy of Applicant's IC Photostat

B) Business Package

• 1 copy of Applicant's IC Photostat
• 1 copy of Form 9 / 24 / 49 (Sdn Bhd)
• 1 copy of Form D (Sole Proprietor / Partnership)