EmailMe Form - Application Form for UniFi HOME

If YES, please fill all the question i, ii and iii.

Are you Streamyx user? *

YES

NO

(i) If YES, what is your existing Streamyx Login ID?
*must fill for Streamyx user.

(ii) If YES, what is your existing Streamyx telephone line no.? :

(iii) Keep Existing Phone Line? :

YES

NO

UniFi Package : *

Please refer http://telecomninterestonlinebm.blogspot.com/ for the packages.

NEW Preffered LoginID 1: *

5-20 Characters. xxxxx@unifi.com

NEW Preffered Login ID 2: *

5-20 Characters. xxxxx@unifi.com

NEW Preffered Login ID 3: *

5-20 Characters. xxxxx@unifi.com

Name of Applicant : *

* must same with NRIC

Applicant IC No: *

(Example: 721010145243)

Applicant Old IC No:

(This is required if applicant born in 1977 or before 1977)

Contact Email : *

Mobile Number : *

Installation Address : *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Please fill (-) for empty space. Must same with TNB address bill.

Property Type : *

Landed

High Rise (5-Storey or more)

Copy of Applicant NRIC *