SERVICE ORDER FORM - RESIDENTIAL PACKAGE


1.  Please read all the Terms & Conditions accompanying the subscription of the Service(s) before completing this application form.
2.  Please write in CAPITAL LETTERS and tick (✔) where required.

APPLICATION TYPE


(Please choose your application request)
   

A. APPLICANT'S INFORMATION

Full Name
Nationality
 
Gender
 
Date of Birth
NRIC/Passport No.
Staff ID
Email Address
Contact Number (Primary)
Contact Number (Secondary)

Not mandatory

B. INSTALLATION ADDRESS

No.
Level
Block
Street/Lot
City/State
Postcode

C. SERVICE DETAILS

Required For Service (RFS)1
Appointed Representative2
Representative's Contact No
Preferred Timing
 
Billing Cycle
NOTES
1.  Required For Service (RFS) date is subject to the availability of required infrastructure and/or equipment.
2.  The appointed representative must be available during service installation.
3.  Your e-bill will be sent to your registered email address. Early termination will subject to RM500 penalty.

D. PACKAGE DETAILS

1. City Broadband Residential1
2. Add-On
3. Contract Term
NOTES
1.  All packages includes an ONU, WiFi Router and 1 Dynamic IP.
https://www.allo.my/allo-incentive-programme/.
2.  Free broadband package is valid as long as you are under the employment of Allo.

Voice calls are charged at RM0.08/min and low IDD call rates for international calls. All price(s) are subject to 6% Service Tax.

UPFRONT PAYMENT

(Payable to Allo Technology Sdn Bhd prior installation date)

Deposit*
Applicable for Non-Malaysian

*Deposit is refundable upon termination

E. DOCUMENTS AND DECLARATION

Documents Required (please upload here):

✔ Photocopy of NRIC (both sides) or passport (Non-Malaysian)

File allowed (.jpg, .png, .pdf only)*


✔ Photocopy of Staff ID

File allowed (.jpg, .png, .pdf only)*




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