Other app form

Online Product Registration Form

Choose product *

Maxis Home Fibre   Time Fibre Home   P1 ForBiz Fibre

Type of application: *

New   Upgrade

Select Package *

Please select Maxis Fibre 10 Mbps - RM148/month for existing Maxis postpaid subcriber Maxis Fibre 10 Mbps - RM168/month (non Maxis postpaid subscriber) Maxis Fibre 20 Mbps - RM198/month for existing Maxis postpaid subcriber Maxis Fibre 20 Mbps - RM238/month (non Maxis postpaid subscriber) Maxis Fibre 30 Mbps - RM248/month for existing Maxis postpaid subcriber Maxis Fibre 30 Mbps - RM298/month (non Maxis postpaid subscriber) Time Fibre Unlimited Home 8 Mbps - RM129/month Time Fibre Unlimited Home 15 Mbps - RM179/month Time Fibre Unlimited Home 30 Mbps - RM259/month Time Fibre Unlimited Home 50 Mbps - RM399/month Time Fibre Home 100 Mbps - RM179/month Time Fibre Internet Basic 6 Mbps - RM168/month Time Fibre Internet Basic 12 Mbps - RM268/month Time Fibre Internet Basic 24 Mbps - RM368/month Time Fibre Internet Basic 36 Mbps - RM468/month Time Fibre Internet Plus 6 Mbps - RM688/month Time Fibre Internet Plus 12 Mbps - RM1288/month Time Fibre Internet Plus 24 Mbps - RM468/month Time Fibre Internet Plus 36 Mbps - RM1788/month Time Fibre Internet Plus 6 Mbps - RM2288/month ForBiz Fiber 149 - 5Mbps - RM149/month ForBiz Fiber 229 - 10Mbps - RM229/month ForBiz Fiber 329 - 20Mbps - RM199/month * Promotion Price ForBiz Fiber 429 - 30Mbps - RM429/month

Section 1 : Applicant Information

Full Name(Same as in IC) : *

For business registration, please enter your Company's name.

IC Number : *

New or old IC number

Mobile Number : *

Email *

eg. user@gmail.com

Property type : *

Landed   High Rise (More than 5 storey)

Installation Address: *

Street Address *

Address Line 2

City *

State / Province / Region *

Postal / Zip Code *

Country *

Billing Address:

Leave this blank if the billing address is the same with installation address

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Prefered login

If more than 1 seperate with coma eg steven12,steven81

Prefered Installation Date (at least 1 week after the registration date)

01 02 03 04 05 06 07 08 09 10 11 12 MM / 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 DD / 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 YYYY

Section 4 : Attachment You may skip this section and send to myonlinebroadband@gmail.com later

Please attach your photocopy/picture of both side of IC(Home package)

Remarks(optional) :

None

*

I hereby acknowledge that the above information is correct and I understand that any incorrect information may result in delay on the application process.

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