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)

    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

    Outbound Link