Apply Fiber Allo City Broadband

Personal

Business

Contract Duration*

Period

Internet Package*

100 Mbps and above recommended for streaming, online gaming, online meeting & more

Internet Package*

12- month contract has one-time charge of RM 300 (non-refundable) in the first-month bill

100 Mbps and above recommended for streaming, online gaming, online meeting & more

Voice Package (home wireless phone) *optional

DectPhone + RM 20

Personal Details*

Full Name (as per MyKad/Passport)

Nationality*

Phone Number*

Secondary Phone Number (family members)*

MyKad Number*

Front IC*

Back IC*

Email address*

Confirm Email address*

House Number*

Street / Lot

City / State

Postcode

I hereby consent to the collection, use, disclosure of my personal information in accordance with the Privacy Policy available on https:// www.citybroadband.my/privacy-policy-2/.

I hereby declare that the above information, documents and any appendices attached are true and valid. I have read and understood the contents of this form and agreed to be bound by general Terms & Conditions as stated on the https://www.citybroadband.my/terms-conditions/ which accompany the subscription of product(s) and/or service(s).

Special Remark

Upload your signature here*

Referral Program

Referral Code

for agent and sales team only

Any issue regarding registration kindly click WhatsApp button at contact us for further assistance

This field should be left blank

Contract Duration

Period

12-month contract has one-time charge of RM 400(non-refundable) in the first-month bill.

Internet Package

100 Mbps and above recommended for streaming, online gaming, online meeting & more. FREE DECT phone(wireless phone) only available for business package 100 mbps and above.

Company Info

Company Type

Company Name

Business Registration Number

Director / Authorised Personal Info*

Full Name (as per MyKad/Passport)

Nationality

Phone Number

Secondary Phone Number (optional)

MyKad Number *

Front IC*

Back IC*

SSM Certificate*

Email address*

Building Name / Apartment Name / Condo Name

Address

Floor No.

Unit No.

City / State*

Postcode*

I hereby consent to the collection, use, disclosure of my personal information in accordance with the Privacy Policy available on https:// www.citybroadband.my/privacy-policy-2/.

Special Remark

Upload your company stamp with SSM registration number or owner/responsible management signature.*

REFERRAL CODE

For agent and sales team only

Any issue regarding registration kindly click WhatsApp button at contact us for further assistance

This field should be left blank

Apply Fiber Allo City Broadband

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