Streamyx App form

Unifi/Streamyx Product Registration/Upgrade Form

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 *

Section 2 : Service details

Type of application: *

New   Upgrade

Current package :

* For upgrade only eg. Streamyx 1mb

Product Package : *

Unifi VIP5 (RM149/month) Unifi VIP10 (RM199/month) Unifi VIP20 (RM299/month) Unifi BIZ5 with dynamic IP (RM199/month) Unifi BIZ10 with Dynamic IP (RM289) Unifi BIZ10 with Fixed IP (RM599) Unifi BIZ20 with Dynamic IP (RM359) Unifi BIZ20 with Fixed IP (RM899) Streamyx (Blockbuster Deals) 512K - RM90 (Free Wireless Modem) Streamyx (Blockbuster Deals) 1.0M - RM110 (Free Wireless Modem) Streamyx (Blockbuster Deals) 2.0M - RM130 (Free Wireless Modem) Streamyx (Blockbuster Deals) 4.0M - RM140 (Free Wireless Modem) Streamyx (Student Package) 1.0M - RM100 (Free Modem) (Waive Activation and Free Installation) Streamyx (Student Package) 2.0M - RM120 (Free Modem) (Waive Activation and Free Installation) Streamyx (Student Package) 4.0M - RM130 (Free Modem) (Waive Activation and Free Installation)

Prefered Installation Date (at least a week after the registration)

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

Prefered login

Section 3 : For current Streamyx subscriber only

Streamyx Login ID:

TM Homeline Number :

Please indicate your choice :

Keep both Streamyx & TM Homeline service   Terminate Streamyx only   Terminate TM Homeline only   Terminate both Streamyx & TM Homeline service

Section 4 : Attachment

Please attached your IC(Home package) or Company SSM Form(BIZ package) For student package please attach a copy of your student ID.

Upload your clear scanned/photo of both side of your I/C (Individual application) or company's SSM/Form 9File (Business registration) You may skip this and email the attachment to myonlinebroadband@gmail.com after the submission had been made.

Extra Remarks(optional) :

None Referreal name, special instructions etc

*

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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