Requisition Form - Customer Rev No. : redONE-RF vers.

001
Last Rev Date : 25/10/16

Please write in capital letters. Tick or delete where applicable.

A. Customer Details
Name (as per IC/MyKad) Mr. Ms. Mdm. Others (e.g Dr. / Dato. etc.) Non Malaysian

NRIC / MyKad No. - - Old IC / Passport

redONE Mobile No. redONE Account No.

B. Services Required
Call Divert (RM3/month) Caller Line ID Restriction (CLIR) (RM10/month) International Direct Dial (IDD)
International Roaming - for postpaid only
(RM300 Deposit) Printed Itemised Bill (RM5/month) Black Berry Services (RM5/month)

Others

If Applicable (For Postpaid Only)

100MB 1GB 2GB 3GB 5GB No Data

500MB 1GB+ 2GB+ 3GB+ 5GB+ Pay Per Use (PPU) (RM0.10/MB)

C. Other Services / Facilities

Bill Printing (Postpaid) Month(s) Required

Change of Address

Postcode

Change of:
Contact No. (Home) Contact No. (Office) Ext No.
Email Fax No. -

Temporary Disconnection Reconnection

SIM Card Replacement

SIM Serial No.
(Affix SIM Card Sticker)
Reason for Replacement

If Applicable (For Postpaid Only)

Change of Old Mobile No. Change to New Mobile No.

Change of Old Package Change to New Package

If Applicable (For Prepaid SIM Replacement Only)

List of 5 Frequent Called No. : 1. 2.

3. 4. 5

Last Top Up Amount (RM)

D. Customer Declaration
I hereby declare that all the above information is true and complete. I would like to have Company Stamp
the selected service(s) rendered. I have read, understood and agreed to be bound by (If applicable)
the Term & Conditions if the Customer Agreement. I am also to be severally liable for all
fees and charges.

Applicants Signature
Date : - -
d d m m y y y y

E. redONE Use Only

Processed By: Approved By:

Date : - - Date : - -
d d m m y y y y d d m m y y y y

Red One Network Sdn. Bhd. (619094-D). A-03-42, Block A, Third Floor, IOI Boulevard, Jalan Kenari 5, Bandar Puchong Jaya, 47170 Puchong, Selangor.
Customer Careline : 1800-11-0800 www.redONE.com.my