Infolient home Broadband Registration Form

A. TYPE OF APPLICATION
Type of Application Package
Value Added Services
 
 
INPORTANT ACKNOWLEDGEMENT
1.
 INFOLIENT Home Broadband is applicable for home application only
2.
 Minimum subscription period is 12 months for all packages except other promotion package
3.
 Speed of service is on best effort basis
4.
 Customer is NOT ALLOWED to change the telephone number(Connecting to INFOLIENT Broadband) before installation of the service
5.
 First bill will includ the following fees:
 
  1. RM88.00 for activation
  2. RM100.00 for installation(If applicable)
  3. RM10.00 for stamp duty
  4. Delivery charges of modem
  5. Other add-on services
  6. If customer terminates INFOLIENT Broadband before the end of minimum subscription period, the customer must pay subscription fees of the remaining month and return the modem. Pre matured termination includes relocation of premise
  7. INFOLIENT Broadband bill must be paid before the due date to avoid any service suspension. During suspension period INFOLIENT Broadband will continue to charge for monthly subscription fee. RM 10.00 reconnection fee will be charge upon service reactivation
  8. INFOLIENT Broadband (Modem Set) forms part of the terms and condition for INFOLIENT Broadband subscription
  9. Customer is responsible to self-install once modem recieved if the installation is done by the customer
  10. Any faulty modem must be returned along with the INFOLIENT Broadband modem acceptance form for modem replacement within the warranty period
  11. If customer is not available during delivery of the modem set, acceptance by a third party will be considered as successful delivery of the item to the customer
   
SUPPORTING DOCUMENTS REQUIRED
Home Application
1.
 Photocopy of authorized signatory's NRIC(Both Sides) or Passport (Non-Malaysian)
2.
 Photocopy of the phone bill
Enterprise/Organization Application
1.
 Photocopy of authorized signatory's NRIC(Both Sides) or Passport (Non-Malaysian)
2.
 Photocopy of the phone bill
3.
 Form 9 or 24 or 49 (Company)
4.
 Forms D & A (Sole Proprietor)
5.
 Forms D & B (Partnership)
B. HOME APPLICANT INFORMATION
Name of Applicant
(As per NRIC/Passport)
Address

City
Postcode  
State
Tel. No
- (Where Broadband is to be connected)
Home No.
- (For Personal Aplicant)
Mobile No.
-
Email
NRIC
Passport No.
C. INSTALLATION INFORMATION
Address

City
Postcode  
State
Fixed Phone Line Number for Broadband Service
-
D. INVOICE & BILLING INFORMATION
Billing Name
Billing Address

City
Postcode  
State
Tel
-
Email
E. MODEM DELIVERY INFORMATION
Name
Address

City
Postcode  
State
Tel
-
I #, NRIC No. # hereby confirm that I have read, understand and agree to authorize a third party t receive the modem set on my behalf by signing the INFOLIENT Broadband Modem Acceptance Form.


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