UniFi Residential Application Information
Package (required) ---Promo UniFi 100Mbps + Jumbo Lite@RM129Promo UniFi 10Mbps + Jumbo Lite@RM129Promo UniFi 30Mbps + Jumbo Lite@RM139Promo UniFi 100Mbps + Ultimate@RM159
Property Type (required) ---LandedHigh Rise (5 Storey and more)
Contact Person Name (required)
Country ---MalaysiaAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArctic OceanArubaAshmore and Cartier IslandsAtlantic OceanAustraliaAustriaAzerbaijanBahamasBahrainBaker IslandBangladeshBarbadosBassas da IndiaBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandClipperton IslandCocos IslandsColombiaComorosCook IslandsCoral Sea IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDemocratic Republic of the CongoDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaEuropa IslandFalkland Islands (Islas Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern and Antarctic LandsGabonGambiaGaza StripGeorgiaGermanyGhanaGibraltarGlorioso IslandsGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHowland IslandHungaryIcelandIndiaIndian OceanIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJan MayenJapanJarvis IslandJerseyJohnston AtollJordanJuan de Nova IslandKazakhstanKenyaKingman ReefKiribatiKerguelen ArchipelagoKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMidway IslandsMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNavassa IslandNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorth SeaNorthern Mariana IslandsNorwayOmanPacific OceanPakistanPalauPalmyra AtollPanamaPapua New GuineaParacel IslandsParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunionRepublic of the CongoRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSpainSpratly IslandsSri LankaSudanSurinameSvalbardSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTromelin IslandTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUSAUruguayUzbekistanVanuatuVenezuelaViet NamVirgin IslandsWake IslandWallis and FutunaWest BankWestern SaharaYemenYugoslaviaZambiaZimbabwe (Only for Passport)
NRIC or Passport No (required)
Mobile No (required)
Date of Birth (required)(e.g. 04/14/1944)
Email (required)
Preferred Communication MailE-mailOffice PhoneMobile
VAS(value added service)
Value Added Service JUMBO PACK@RM60SPORT PACK@RM50ANEKA PACK@RM30RUBY PACK@RM40VARNAM PACK@RM30NONE
UniFi Residential Installation Address
Address (required)
City (required)
State (required) ---JohorKedahKelantanMelakaNegeri SembilanPahangPerakPulau PinangPerlisSabahSarawakSelangorTerengganuWilayah Persekutuan KLWilayah Persekutuan LabuanWilayah Persekutuan PutrajayaOthers
Postcode (required)
UniFi Residential Billing AddressSame as Installation Address
Address
City
State ---JohorKedahKelantanMelakaNegeri SembilanPahangPerakPulau PinangPerlisSabahSarawakSelangorTerengganuWilayah Persekutuan KLWilayah Persekutuan LabuanWilayah Persekutuan PutrajayaOthers
Postcode
Please enter 4 digit for telephone no (xxxx last 4 digit only)
Preferred UniFi ID (20 chars)
UniFi Residential Additional Information
Dealer Remarks
Supporting Documents (Max 1mb gif png jpg jpeg)(Void for TM use)
NRIC Front or Passport (required)
NRIC Back
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UniFi 100m RM129
