Registration Form – Residential Broadband

FRESHTEL INTERNET SDN BHD (1154469-D)

Lot 11, 2nd Floor, Millerz Square @ Old Klang Road,

No. 357, Jalan Kelang Lama, 57000 Kuala Lumpur.
Customer Support: +603 9078 2963 |
Website:https://www.freshtel.my

You may register for the complimentary use of Internet Service online (by scanning the QR Code, or
https://portal.freshtel.my/redeem) or by filling this form and emailing to reg@freshtel.my.

ACCOUNT DETAILS
SECTION A: SERVICE PLAN
Service Location: The Arcuz @ Kelana Jaya Jalan PJU 1A/4F, SS 7, 47301 Petaling Jaya, Selangor
Please indicate where applicable:

SERVICE PLAN
12 Months
12 +12 Months
Bandwidth Contract (Monthly Data (✓) Data (✓)
Subscription)
(One Time Fee)

100 Mbps 12 Months Complimentary-use @ RM99 Redeem □ N/A

200 Mbps 200 Mbps @ RM129 / Month RM 30 □ RM 1,600 □

300 Mbps 300 Mbps @ RM149 / Month RM 70 □ RM 2,200 □

500 Mbps 500 Mbps @RM179/Month N/A RM 2,800 □
*Voice / Phone service upon request only

SECTION B: DOCUMENT REQUIRED

Please indicate where applicable:

⌦ Provide copy of: □ NRIC (for Malaysian) □ Passport (for Non-Malaysian)

st
□ S&P 1 page/ VP letter

SECTION C: CUSTOMER INFORMATION

Customer Name NRIC / Passport No.

Installation Unit ( ) Block ( ) Unit ( )

Telephone No Mobile No

Email Address
*Monthly billing statement will be sent via email and through customer portal
Preferred
Installation Date

FOR FRESHTEL USE ONLY

Assigned Account Code

Remarks:

Verification
Verified by: Verified Date:
Completed

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SECTION E: CUSTOMER ACKNOWLEDGEMENT
ACKNOWLEDGEMENT

I, NRIC / Passport Number hereby

accept any and all responsibility for the installation of Freshtel’s service and I understand and agree to accept and be bound by the terms and
conditions (https://www.freshtel.my) which accompany the usage of the Freshtel service. The terms and conditions are subject to change by
Freshtel Internet Sdn Bhd (Formerly known as Freshtel Group Sdn Bhd). I will be notified in a manner where necessary and appropriate. I
confirm that the information given herein is correct and accurate. I understand Freshtel reserves the right to verify any information provided
by me concerning this application.

Contract Period / Termination / Refund

The Service will continue automatically upon expiry of the Contract Period on a month to month basis unless otherwise terminated by me in
writing or official. The penalty will be charged if I Terminate the Service before the expiry of the Contract Period if any. Deposit refund (if any)
will be 45 working days after the termination date (last date of the service month) and after returning all the devices to Freshtel. Payment
advance (if any) only can be converted on last month usage. Refund will be returned to the account holder name only. If I fail to return the
equipment in a good working condition to Freshtel Internet's designated drop-off area upon the termination accepted, the Company has the
right to impose an RM450.00 fee to me as the compensation fee to the faulty or missing equipment.

Consent
In according to the Credit Reporting Agencies Act 2010 and Central Bank of Malaysia Act 2009, I/we the undersigned, do hereby irrevocably
and unconditionally give consent to you, your appointed registered credit reporting agency(ies) and/or any debts collecting agency(ies)
appointed by you to process my/our companies and personal data such as conducting credit/trade check, CTOS and DCHEQS checks on me/us
and where applicable, our director(s), shareholder(s), and guarantor(s) [collectively the "Parties"], with your appointed registered credit
reporting agency(ies) and/or debts collecting agency(ies) appointed by you at any time for as long as the Parties have a trade relationship
with you or where any dues remain unpaid and outstanding with you for the purposes of, (a) opening of the account; (b) debt recovery; (c)
credit/account review; (d) legal documentation consequent to a contract or facility granted by you; (e) credit/account monitoring and (f)
credit/account evaluation. You and/or your appointed debts collecting agency(ies) may disclose any information on the Parties conduct of
their accounts with you to any business entity(ies) for bona fide trade checking at any time. The Parties are also aware and understand that
such information will be provided to your credit reporting agency(ies) and/or debts collecting agency(ies), who may, in turn, share such
information to subscribers of their Service. Where you require any processing of our application to be processed by any processing centre
located outside Malaysia (including your Head Office), the Parties hereby give consent to your appointed registered credit reporting
agency(ies) and/or debts collecting agency(ies) to disclose their credit reports to such locations outside Malaysia. Apart from that, the Parties
undersigned give my/our consent to you and your appointed registered credit reporting agency(ies) and/or your debts collecting agency(ies),
to process my/our personal data as per the Personal Data Protection Act.

Service
I understand I am provisioned with high-speed internet access from my home, either with or without a voice service, based on the plan that
I have subscribed to in the registration form. I am aware that the package detail is available on https://portal.freshtel.my/plan-package-
adviser; Freshtel Internet may change the plans periodically, but such change does not change the Service I have subscribed. The Service is a
personal fixed high-speed internet access that enables me to access the world wide web and any offerings or services available thereon, but
I will be responsible for the risk whenever I am accessing these services. Freshtel Internet Sdn Bhd will provide me with a Service comprising
standard service components: an Optical Network Unit ("ONU") and a Wi-Fi router. I understand Freshtel Internet Sdn Bhd aims to provide
a continuous, high-quality service using reasonable care and skill on a best efforts basis. However, I understand Freshtel Internet Sdn Bhd
can't guarantee that it'll be available all the time due to the nature of the Service and the Service Equipment Freshtel Internet Sdn Bhd uses
to provide the Services.

CUSTOMER SIGNATURE DATE OF APPLICATION

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