Streamyx & Unifi Registration Form

Please kindly select
the type of application: *

Upgrade From Streamyx

New Application
Unifi Residential Package
Unifi Business Package
Streamyx Package
Registration Type Selected: " Upgrade "
Existing Streamyx Login ID:
Existing Service No

03-XXXXXXXX
Keep Existing Phone Line:
Application Details
Name *
New NRIC *

XXXXXX-XX-XXXX
Old NRIC /
Business Registration
Number
Email *

* email billing will save RM8/mth
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Contact Number *

012-3456789
Installation
Contact Person *
Installation
Contact Person IC No *

XXXXXX-XX-XXXX
Installation
Contact Number *

012-3456789
Preferred Login 1 *

Note: 6 - 20 characters (Only alphanumeric allowed, please do not insert symbol such as "-", "." etc).
Preferred Login 2 *
Preferred Login 3 *
Installation Date & Time: *
MM / DD / YYYY HH : MM AM/PM
For Residential
Ic photocopy
(front & back) *
For Business
SSM Business Registration *
Remarks
Bank Details for 100% rebate

will bank in to your account 1 month after the INSTALLATION SUCCESSFULLY
Bank *

Maybank / CIMB / HongLeong / Public / HSBC
Account Number *
Image Verification

Please enter the text from the image:
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