Maxis Home New Application


Maxis Home New Application

Maxis home new application, promotion, check coverage.

A. Maxis Home New Individual

Title (required)
Mr.Ms.Others (Please specify)

Full Name (as in NRIC or Passport)(required)

Gender
MaleFemale

NRIC or Passport No (required)

Date of Birth (required)(e.g. 04/14/1944)

Contact No

Mobile No (required)

Alternative Contact No

Nationality
MalaysianNon-Malaysian

Race
MalayChineseIndianOthers

Email (required)

B. Maxis Home New Installation Address

Hse/Apt/Lot/Unit No (required)

Floor No

Block Name

Building/Apt Name

Street No/Name (required)

Garden/Section

City

Postcode (required)

State

Country

Preferred Installation Date (e.g. 04/14/1944)(Installation is typically conducted between 2-4 weeks after you register for the Service. Should you require the installation to be done after 4 weeks, please select your preferred date)

C. Maxis Home New Billing AddressSame as Installation Address

Address

City

State

Postcode

Additional Note

D. Maxis Home New Service Packages

Package (required)

Dealer Remarks

E. Maxis Home New Supporting Documents (Max 1mb gif png jpg jpeg)(Void for Maxis use)

NRIC Front or Passport (required)

NRIC Back

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