IP CENTREX A branding arm of

Telekom Malaysia Berhad

(128740-P)

APPLICATION FORM
SECTION 1: SERVICE DETAILS

All prices quoted in the Quotation attached to this Application Form or on the basis of published rate, as the case may be, shall be payable on a monthly
basis, unless mentioned otherwise:

New Add/Remove/Change Line

Type of application* STAMP DUTY

Existing Customer
Modify Hotline Number

Others (Termination/Relocation/Transfer Ownership/Modify Pilot Number)

Package* IP Centrex

Temporary IP Centrex

Hunting Features* Yes No Calling Line Identification Presentation (CLIP) (Optional)

No of Lines*

Hotline Number : Preferred Installation Slot*

(Installation date & time is subject to slot availability.
The earliest date is 5 days after form submission)
Government
Enterprise
Segment* Date 1 : ____________________________ Time: AM/PM

SME Residential Date 2 : ____________________________ Time: AM/PM

Date 3 : ____________________________ Time: AM/PM

Others
Activation Date : ___/___/___ (to be filled after service
successfully installed at customer premise)

SECTION 2: APPLICANT DETAILS

Please write in capital letters and tick (/) where applicable

Customer/Company Name*

Contact Person*

NRIC*

(Malaysian citizens, please enclose a copy of NRIC)

Passport No*

(Non-Malaysian citizens, please enclose a copy of passport)

Property Type*
Landed High Rise
Company Number/ Business
Registration*

Installation Address*

City* Postcode

State*

Mobile No*

Office Tel No*

Preferred Communication *
Email Office Phone Mobile

Email

SECTION 3: EXISTING BILLING INFORMATION (Mandatory for existing TM Business customer)

Kindly fill in the following:

BAU Billing Account*

Service No 1*: Service No 2*: Service No 3*:

Service No 4*: Service No 5*: Service No 6*:

Please indicate your

choice : Terminate TM Fixed Line only

Others : ____________________________

SECTION 4: SERVICE DETAILS

(Applicable for new customer) Modify Pilot Numbers (Applicable for existing customer)
___________________________________
Pilot Numbers Old Pilot Number: ______

Range Service Numbers : Range DDI Numbers : to

to New Pilot Number :

Range DDI Numbers : to

 SECTION 5: BILLING INFORMATION

Kindly fill in the following:

For billing media, please choose one: Email (FREE) Itemised Paper (RM4)

Email*

Billing
Address*

City* Postcode

State*

SECTION 6: AUTOPAY

I/We hereby agree to register and sign-up for the Autopay service which the payment of my bill(s) pursuant to this Service shall be charged to my credit card
specified in this application form. I/We further acknowledged that I/we have read and understood the terms and conditions of the Autopay Service which is
available for viewing at www.tm.com.my and agree to be bound by the said terms and conditions.

Cardholder Name

NRIC No

Correspondence
Address*

Mobile No.* Home Tel. No.

Email*

Credit Card No. Expiry Date / /

Card Issuer (Bank)

VISA Mastercard AMEX Diners Club

* Mandatory field.
SECTION 7: IMPORTANT NOTES (MUST READ) please read and tick

General (Migration Customer)

IP Centrex is offered to existing residential and business customer affected with migration of TM’s exchange (from non -HSBB to HSBB network) as
shall be approved by TM.

The customer hereby acknowledges that the customer will get new IP Centrex billing account number.

In the event the Customer terminates the IP Centrex before the expiry of the Minimum Subscription Period, the Customer shall be liable to pay an
administration fee of RM212.00 per line to TM. The Minimum Subscription Period for IP Centrex Basic is 12 month.

The customer shall be liable to pay TM for any TM’s Equipment (BTU, ATA & SLT) which the Customer fails to return or surrende r to TM upon
termination of the Service as follows, RM 530 for BTU, RM 350 for 4 Ports, RM 1060 for 8 Ports and RM 2,120 for 16 Ports and RM 66 per telephone
set. TM reserves the right to determine any other rate as maybe notified to customer from time to time.

Installation fee will not be charged to customer of IP Centrex. For the avoidance of doubt, installation fee only covers the standard IP Centrex
installation practice. This excludes additional charges imposed by external contractors for any request by the Customer to perform a non-standard
internal wiring including concealed wiring, over ceiling, customised wiring and any other works which is beyond the standard IP Centrex installation
practice.

The customer hereby acknowledges that the existing phone set and/or Service number will be maintained for the purpose of prov isioning the
Service to Customer.

The customer acknowledges that TM will not maintain IP Centrex service number if customer request to subscribe UniFi service.

The outstanding balance and deposit from previous service or bill will be transferred and adjusted in IP Cent rex bill account.

The Customer acknowledges that no new phone set will be given for the migration to the IP Centrex service.

Any existing Auto pay billing account will not carry over to system and customer needs to re -register to a new billing account for the IP Centrex.

General (New Customer)

IP Centrex is offered to new customers including residential and business customer in HSBB area as shall be approved by TM.

The customer hereby acknowledges that the customer will get new IP Centrex billing account number and new service number.

In the event the Customer terminates the IP Centrex before the expiry of the Minimum Subscription Period, the Customer shall be liable to pay an
administration fee of RM212.00 per line to TM. The Minimum Subscription Period for IP Centrex Basic is 12 month.

Fees that Customer will pay TM for the subscription of the IP Centrex comprises of one time charge and monthly recurring char ges (rental charges
and usage fee) at the applicable rate indicated in the Quotation or at such other published rate ( for usage fee) as may be determined by TM from
time to time. Published rate are subjected to changes from time to time as may be determined by TM.

The customer shall be liable to pay TM for any TM’s Equipment (BTU, ATA & SLT ) which the Customer fails to return or surrender to TM
upon termination of the Service as follows, RM 530 for BTU, RM 371 for 4 Ports, RM 1060 for 8 Ports and RM 2,120 for 16 Ports and RM69.69 per
telephone set. TM reserves the right to determine any other rate as maybe notified to customer from time to time.

Installation fee will be charged to customer of IP Centrex. For the avoidance of doubt, installation fee only covers the stan dard

IP Centrex installation practice. This excludes additional charges imposed by external contractors for any request by the Customer to perform a non-
standard internal wiring including concealed wiring, over ceiling, customised wiring and any other works which is beyond the standard IP Centrex
installation practice.

The Customer acknowledges that new phone set will be given to the IP Centrex service.

Downtime

TM shall not be responsible for service downtime or/and interruption during migration activity.
Installation

Installation time for fibre installation in landed properties is between 5 to 8 hours. For high rise buildings utilizing Very High
Speed Digital Subscriber (VDSL2) technology is between 2 to 3 hours.

Internal concealed wiring will not be carried out by TM. However, customers can arrange their own or choose from TM’s authorized list of contractor
at their own expense.

IP Centrex account owner or authorized person must be available during the IP Centrex service installation t o sign-off on the installation process.

The customer will be responsible for providing the TV and 4-socket extension cord to complete the installation (if any)

Minimal drilling is required for fibre installation to the premise.

TM shall not be responsible for service downtime and any damages resulting from construction and renovation done by Customer .

Product Updates
We would like to share your personal information within TM's group of companies and/or their business affiliates to contact y ou about other products or services
available from TM and its group of companies and their Business affiliates which may be of interest to you.

Please tick the relevant box if you would like to receive marketing and promotional materials from :
TM and its group of companies TM and its group of companies business affiliates.
Please tick this box if you would like to sign up and become a member of the TM Rewards program.
Visit http://www.tm.com.my/tmrewards for more information.

SECTION 8: CUSTOMER’S INFROMATION AND PRIVACY NOTICE SECTION 8: CUSTOMER’S INFROMATION AND PRIVACY
NOTICE

IMPORTANT NOTIFICATION: CUSTOMER’S INFORMATION AND PRIVACY POLICY

By submitting the Application Form, Customer is providing information/personal information to TM.

TM will be processing Customer’s information/personal information provided in the Application Form and/or further information and data that may be required by
TM either from Customer or from any third parties especially from credit bureau, banks, credit reporting agencies and other businesses that provide like information
or reference agencies from time to time.

The purposes of such processing would include:-

• assessing Customer’s application and/or continued provisioning of the services provided herein (whichever is applicable);
• customising advertisements and content on the website(s) and the sites of TM and its group of companies (for further information on the TM’s group of companies,
please visit www.tm.com.my);
• responding to Customer’s enquiries;
• research purposes including historical and statistical purposes;
• general operation and maintenance of the services or goods provided herein including audit and its related website(s); • matching any data held by TM or its group
of companies relating to Customer from time to time;
• provide Customer with regular communications (other than direct marketing materials) from TM relating to the services or go ods provided herein; and
investigation of complaints, suspected suspicious transactions and research for service or goods improvement.

By submitting the Application Form, Customer consent and authorise TM obtaining and verifying any information about Customer which TM may require in
connection with Customer’s application for any of TM’s services and/or review of the existing account with TM from any third party, especially credit bureau or
reference agencies. Such consent and authorization herein will extend to any information obtained from any of the account(s) presently maintained for Customer,
any new application for any form of services rendered or goods provided by TM, such historical financial or credit records, data or information whether or not
provided personally or by any other sources relating to Customer which was collected, gathered, received, captured, compiled, secured and/or obtained by TM
through or by whatever means or methods or forms.

The information as required herein (unless stated otherwise) is obligatory on Customer and failure by Customer to provide any information as required may affect
Customer’s application or the continued provisioning of the services provided herein.

In the course of processing this application, TM may disclose Customer’s personal information to the following parties for the pur poses stated above:-
• TM’s service providers or agents who are involved in providing the services or goods provided herein; • third parties (including those overseas) who provide data
processing services;
• any credit reference agencies or, in the event of default, any debt collection agencies;

• any person, who is under a duty of confidentiality to which has undertaken to keep s uch data confidential, which TM has engaged to fulfil its obligations to
Customer; and
• any actual or proposed assignee, transferee, participant or sub-participant of TM’s rights or business.

TM may also disclose Customer’s personal information if required to do so by law or in good faith, if such action is necessary to (i) comply with any law enforcement
agency requirement, court orders or legal process or; (ii) protect and defend the rights or property of TM and its group of c ompanies and their users.
If Customer would like to make any inquiries or complaints or request access or correction of Customer’s personal information , Customer may also contact TM
Contact Centre or Customer can visit the nearest TMpoint. Any request of access of correction of personal data may subject to a fee and also to any privacy or data
protection laws.
Where Customer elect to limit TM’s right to process personal information, Customer may contact Customer Support at
http://www.tm.com.my/ap/contact/Pages/contactus.aspx or 100 or TM Privacy Officer in writing. For avoidance of doubt, the limitation does not include
processing of mandatory personal data. TM may review and update this privacy policy from time to time to reflect changes in t he law, changes in our business
practices, procedures and structure, and the community’s changing privacy expectations. While it is not generally feasible to notify Customer of changes to this
privacy policy, the latest version of the privacy policy may be available on TM’s website or Customer can contact our Privacy Officer to obtain the latest version of the
Privacy Notice at any time.

SEKSYEN 8: MAKLUMAT PELANGGAN DAN NOTIS PRIVASI

SEKSYEN 8 : PEMBERITAHUAN PENTING: MAKLUMAT PELANGGAN DAN POLISI PRIVASI

Dengan menyerahkan Borang Permohonan, Pelanggan akan memberikan maklumat /maklumat peribadi kepada TM.

TM akan memproses maklumat/maklumat peribadi Pelanggan yang diberi dalam Borang Permohonan dan/atau maklumat lanjut serta dat a yang mungkin
diperlukan oleh TM sama ada dari Pelanggan atau dari pihak ketiga terutamanya dari biro kredit, bank, ejen pelapor kredit dan perniagaan-perniagaan lain yang
memberikan maklumat sedemikian atau agensi rujukan dari semasa ke semasa.

Tujuan-tujuan untuk pemprosesan ini adalah termasuk:-

• menilai permohonan Pelanggan atau meneruskan peruntukan perkhidmatan yang diberikan di sini (yang mana berkenaan);

• menyesuaikan iklan-iklan dan kandungan di laman web TM dan syarikat-syarikat kumpulan TM (untuk maklumat lanjut syarikat-syarikat kumpulan TM, sila layari
www.tm.com.my);

• menjawab pertanyaan-pertanyaan Pelanggan;

• tujuan penyelidikan termasuk tujuan rekod dan statistik;

• operasi umum dan penyelenggaraan perkhidmatan-perkhidmatan atau barang-barang yang diberikan di sini termasuk audit serta laman-laman web yang
berkenaan;

• pemadanan apa-apa data yang disimpan oleh TM atau syarikat-syarikat kumpulan TM yang berkenaan dengan Pelangga dari semasa ke semasa;

• menyediakan komunikasi yang kerap (selain daripada bahan-bahan pemasaran langsung) dari TM kepada Pelanggan untuk perkhidmatan atau barangan yang
diberikan di sini; dan

• penyiasatan aduan, transaksi-transaksi yang mencurigakan dan penyelidikan untuk pembaikan perkhidmatan dan barangan.

Dengan menyerahkan Borang Permohonan, Pelanggan bersetuju dan memberi kebenaran kepada TM untuk memperolehi dan mengesahkan apa-apa maklumat
berkenaan dengan Pelanggan yang mana diperlu oleh TM berkenaan dengan permohonan Pelanggan untuk apa-apa perkhidmatan-perkhidmatan TM dan/atau
semakan akaun yang sedia ada dengan TM daripada pihak ketiga, terutamanya biro kredit atau agensi rujukan. Persetujuan dan kebenaran di sini akan meliputi apa-
apa maklumat diperolehi daripada apa-apa akaun(-akaun) yang pada masa ini diselenggara untuk Pelanggan, sebarang permohonan baharu untuk apa-apa bentuk
perkhidmatan yang disediakan oleh TM, seperti latarbelakang kewangan atau rekod kredit, data atau maklumat sama ada diberi se cara peribadi atau dari apa-apa
sumber yang berkaitan dengan Pelanggan yang telah diambil, dikumpul, diterima, ditangkap, digabungkan, dilindungi dan/atau diperolehi oleh TM melalui apa jua
kaedah atau cara atau bentuk.

SECTION 9: APPLICANT ACKNOWLEDGEMENT

I, _______________________________________ (IP Centrex Services Applicant) NRIC No./Company No./Business Registration

No._____________________________ hereby accept any and all responsibility for the IP Centrex service and agree to be liable for any demand/claim and any cost
arisingfrom legal pertaining to my usage of the IP Centrex service. I understand and agree to accept and be bound by Terms and Conditions which accompany the
usage of the IP Centrex service. These Terms and Conditions may be subject to change by Telekom Malaysia Berhad, and I will b e notified in a manner as Telekom
Malaysia Berhad deems appropriate. I confirm that the information given herein is true and correct.

Date (dd/mm/yyyy) / /
Customer’s Authorized Signature & Stamp

Upon receipt of this application, Telekom Malaysia Berhad reserves the right to verify any information provided by you and reserves the right to decline any
application without any reason thereof and is not obligated to respond to any request on any unsuccessful application. Kindly attach a certified true copy o f NRIC or
passport/Company No./Business Registration No./Business Registration Certificate.
SECTION 10: : FOR TM USE ONLY

AE Staff ID : Division/Unit :
Office Telephone No. : Fax No. :
Order No. (NOVA) : Pilot No. :
Account No. : Date :_____/_____/______ (dd/mm/yyyy)
Range DDI Reservation Numbers :

Upon receipt of this application, Telekom Malaysia Berhad reserves the right to verify any information provided by you and reserves the right to decline any
application without any reason thereof and is not obligated to respond to any request on any unsuccessful application.