Scribd
Upload
68 views4 pages

Application Form PR1MA COMM 2024

terteteteterttertteteeeteetetteteetetet

Uploaded by

Shahid Tajuddin
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
68 views4 pages

Application Form PR1MA COMM 2024

terteteteterttertteteeeteetetteteetetet

Uploaded by

Shahid Tajuddin
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 4

SUBSCRIBER’S APPLICATION FORM AND AGREEMENT

FOR PR1MA COMM RESIDENTIAL BROADBAND PLAN


Type of Application:
 New application / Change of Plan
IMPORTANT: PLEASE READ THE TERMS AND CONDITIONS CAREFULLY. FILL UP THE DETAILS, ATTACH THE SUPPORTING DOCUMENTS AS
REQUIRED AND E-MAIL TO enquiry@pr1macomm.my APPLICATION MUST BE MADE BY PR1MA HOME’S OWNER OR ANY
AUTHORISED PERSON (AUTHORISATION LETTER FROM THE HOME OWNER IS REQUIRED)
Section A. Particulars of Applicant/Subscriber (“Customer”)
Name as per NRIC: MOHAMAD RAZIF BIN ABDULLAH
NRIC: 850226095067
Installation Address: Billing Information:
NO 50 LORONG 23 PRIMA PADANG SIDING
/
 Please tick if the address is the same as the registration address.

BANDAR PUTRA HEIGHTS Billing Address:

City: Postcode: 026000 City: Postcode:


MALAYSIA
State: PERLIS State:
Email: ajis3682@gmail.com Billing email:

Office Tel No: 04-9761813


Mobile No: 0174006078
Alternative No:
(optional) 0174202981
Section B. Product/Service Details
Type of Product/Service 4. Preferred Installation Date
1. PR1MA Comm Residential Broadband Plan
/
 PR1MA Comm 30 (RM 30)
Date 1: ____/____/____ Time: AM/PM
Date 2: ____/____/____ Time: AM/PM
 PR1MA Comm 60 (RM 79) Date 3: ____/____/____ Time: AM/PM
 PR1MA Comm 100 (RM 99)
 PR1MA Comm 300 (RM 129) *While we exercise reasonable effort to meet your preferred date,
there is no guarantee that we would be able to meet your request.
2. Current Subscribed Package
 PR1MA Comm 30 SCAN QR CODE FOR T&C APPLY
 PR1MA Comm 60
 PR1MA Comm 100

2. VOIP Telephone Line


 PR1MA Comm VoIP (added – RM 10)

Section E. Undertaking

I/We, MOHAMAD RAZIF BIN ABDULLAH


_____________________________________________________________________(Customer’s name),
IC No 850226095067
__________________________________________confirm that the information given herein is correct and hereby
accept and agree to this Terms and Conditions for the Services.
By signing this form, I/We hereby agree that PR1MA Comm shall has the right to obtain, use and process my/our personal data
that I/We have provide in this form for the purposes mentioned in the Personal Data Protection Notice published in
www.pr1macomm.my/pdpa.html

Applicant’s Signature

Name: MOHAMAD RAZIF BIN ABDULLAH Date: 6/11/2024

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy