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SECTION 1 : TYPE OF APPLICATION Type of Application TM Business Broadband Packages (Select one) Must Read Important Acknowledgement Installation Address City New Downgrade SOHO 1 IP 5 IPs Current Promotion Packages ADSL 1.0Mbps ADSL 1.0Mbps ADSL 1.0Mbps (Please specify): Streamyx In-A-Box SDSL 1.5Mbps SDSL 1.5Mbps ADSL 2.0Mbps ADSL 2.0Mbps Type of Collection ADSL 4.0Mbps ADSL 4.0Mbps Upgrade Business Broadband package is applicable for personal and business application. Minimum subscription period is 12 months for all Business Broadband standard packages except other promotion packages. Service is subject to availability and technical testing. Speed of service is on best effort basis. Customer is NOT ALLOWED to change the telephone number (connecting to Business Broadband) before installation of service. Customer is responsible for internal wiring, NIC card and networking. For Streamyx In-A-Box (applicable for SOHO package only) - Auto account activation is 7-days from the date of registration for self collection and 10-days for courier delivery. - RM88 installation fee is applicable only if installation assistance is required. - For account activation, SMS to STXACTV Login ID and send to 33535 three ( 3 ) days after registration. Each reply message from TM will be charged RM0.30 to customer’s mobile phone postpaid account or deducted from their prepaid balance. Telco SMS charges for each message sent is charged separately. - The mobile number used must match the mobile number written in the registration form. Customer may use another mobile number if a personal one is not available. - Streamyx In-A-Box courier service charges are RM14 for Peninsular Malaysia and RM25 for Sabah/Sarawak. For Business Broadband 2.0Mbps and 4.0Mbps package: - Service available in selected areas only. List of the areas is available at www.tm.net.my - Service is subject to availability and technical testing during installation. - For existing customers who want to upgrade to these packages, new modem will be provided. Service interruption will occur for a maximum period of 2 working days. - For existing customers who want to upgrade to these packages and fail to get the service upon service verification during installation, their application will be reverted to their existing packages. All Internet charges will be included in one single bill 'Bil Telefon & Multimedia', (inclusive of telephone charges, Business Broadband charges and others). 1st bill received will include the following fees : - RM75 for activation. - RM88 for installation (if applicable). - First & second months advanced subscription fee. - RM10 for stamp duty fee For account activated on every 29th, 30th or 31st, the current charges for the month will be prorated. If customer terminates Business Broadband before the end of the minimum subscription period, the customer must pay subscription fees of the remaining months and return the modem. Pre-mature termination includes relocation of premise. Business Broadband bill must be paid before the due date to avoid any service suspension. During suspension period, TM will continue to charge for the monthly subscription fee. RM10 reconnection fee will be charged upon service reactivation. SECTION 2 : CUSTOMER INFORMATION Organisation Type Name of Organisation (As per ROC) Tel. No. (Where Business Broadband is to be connected) Applicant Name (Authorised Officer) Designation NRIC of Applicant (Malaysian Citizen – Please enclose a copy of NRIC) Preferred access login ID (Minimum 3 characters, maximum 8 characters) Preferred email login ID (Minimum 3 characters, maximum 8 characters (xxx@streamyx.com)) MNC GOVT SMI NGO Others Postcode State Date of Birth Gender Male Female Office Tel. No. Email Name Business Broadband APPLICATION FORM Telekom Malaysia Berhad (128740-P) Technical Contact 1st Email 2nd Email 3rd Email Office Fax No. Tel. No. Email TM’s Copy Self-collect Courier (Please fill in item 6.0) ADSL 2.0Mbps ADSL 4.0Mbps Required installation date (within 8 days from application date) For upgrade or downgrade, please state existing Login ID Registration No. (Please enclose a copy of Company Registration Certificate) Passport No. (Non-Malaysian Citizen – Please enclose a copy of Passport) 1: 2: 3: 1: 2: 3: 1: 2: 3: 1: 2: 3: Mobile No. Please ask our Sales Representative to explain on the Important Acknowledgement before signing in the box below. I have read, understand and accept the Important Acknowledgement. SECTION 3 : INVOICING AND BILLING INFORMATION Billing Name Billing Address City Postcode SECTION 4 : ACKNOWLEDGEMENT IF APPLICANT IS NOT THE OWNER OF TELEPHONE LINE, PLEASE FILL UP ITEM 5.0a AND 5.0b (*applicable for personal applicant only) Signature of Telephone Owner Note: Copy of telephone owner’s NRIC and telephone bill (telephone line used to install Business Broadband) are required. SECTION 5b : APPLICANT ACKNOWLEDGEMENT (to be filled by applicant) Signature of Applicant SECTION 6 : ACKNOWLEDGEMENT FOR STREAMYX IN-A-BOX DELIVERY VIA COURIER Are you interested to sign-up for Autopay service? I, (Business Broadband applicant name) NRIC No. hereby confirm that I have read, understand and agree to the above Terms and Conditions. In the event that I am not available during the delivery of the Streamyx In-A-Box (modem set) at the address as stated above, I agree to authorise a third party to receive the modem set on my behalf by signing the Streamyx In-A-Box Modem Acceptance Form. State Contact Person’s Email Address I/We have read, understand and agree to accept and be bound by the Terms and Conditions which accompany the usage of Business Broadband access service. These Terms and Conditions may be subjected to change by Telekom Malaysia Berhad, and I/We will be notified in a manner as Telekom Malaysia Berhad deems appropriate. I/We confirm that the information given herein by me/us is true and correct. Upon receipt of this application, Telekom Malaysia Berhad reserves the right to verify any information provided by you and reserves the right to decline any application without giving any reason thereof and is not obligated to respond any request for any unsuccessful application. Kindly attach a copy of NRIC / Passport / ROC. SECTION 5a : THIRD PARTY AUTHORISATION FOR USAGE OF FIXED TELEPHONE LINE BY APPLICANT (to be filled by telephone owner) I, (telephone owner’s name) NRIC No. authorise (Business Broadband applicant name) NRIC No. to apply for Business Broadband via my fixed telephone number . I hereby warrant that the above authorisation is the only authorisation given for the purpose of subscribing for a Business Broadband and I shall NOT authorise the usage of the above telephone number for subsequent application of Business Broadband service to other parties. I, (Business Broadband applicant name), NRIC No. hereby accept any and all responsibilities resulting from the written authorisation by (telephone line owner), NRIC No. and agree to be liable for any demand/claim and any cost arising from legal action pertaining to my usage of the telephone line and the Business Broadband service. I further agree that Telekom Malaysia Berhad shall not be responsible in any way whatsoever for any disruption to Business Broadband service in the event that the owner terminates the telephone line or upon suspension of the telephone line for any reason whatsoever. Please state your delivery address: City Postcode State Additional Terms and Conditions: 1. Streamyx In-A-Box (modem set) forms part of the terms and conditions for Business Broadband subscription. 2. Customer is responsible to self-install once modem received. 3. For account activation, SMS to STXACTV Login ID and send to 33535 three ( 3 ) days after registration. Otherwise the acount will auto activate 7-days from date of registration for self collect and 10 days for courier. Each reply message from Telekom Malaysia Berhad will be charged RM0.30 to customer’s mobile phone postpaid account or deducted from their prepaid balance. Telco SMS charges for each message sent is charged separately. 4. RM88 installation fee is applicable if installation assistance is required and charges shall be included in customer’s bill. 5. Modem belongs to Telekom Malaysia Berhad and must be returned upon termination of service and/or non-availability of service due to line quality. RM150 will be charged in customer’s bill for non returned modem set. 6. Any faulty modem must be returned along with the Streamyx In-A-Box Modem Acceptance Form for modem replacement within fourteen ( 14 ) days from date of activation to any TM Authorised resellers /outlets. 7. If a 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. SECTION 7 : FOR TM USE ONLY Type of service Permanent Temporary (Reason) Account Executive Name Mobile No. Approval for Temporary account Name Designation Signature of Applicant Signature Date Date Date SECTION 8 : FOR AGENT USE ONLY Resellers ID Date Date Official Stamp Resellers Name Yes Country No RM10 Duty Stamp Agents ID Service Activation Date Official Stamp version 11.07
