RESIDENTIAL APPLICATION FORM

Telekom Malaysia Berhad (128740-P)

STAMP DUTY
SECTION 1: TYPE OF APPLICATION
New Registration
Existing/Additional Service (Please state service No.: ) Upgrade/Downgrade (Please state login ID: )
Relocation
Change Ownership
Order ID:
SECTION 2: APPLICANT DETAILS
Malaysian (enclosed copy of MyKad/MyPR)
Non-Malaysian (enclosed copy of Passport) Preferred Language*: Malay English

Name of Applicant*
MyKad/MyPR* Passport No.*
Date of Birth* Gender Male Female
Mobile No.* Homeline No. Other Tel. No.
Fax No. Email*

Please tick this box (�) if you would like to sign up and become a member of the TM Rewards programme. Visit www.tm.com.my/tmrewards for more information.

SECTION 3: INSTALLATION/RELOCATION
Property Type* Landed & High-rise (less than 5 storeys) High-rise (5 storeys or more)
Installation Address*

State* Postcode*
Preferred Installation / 1. Time: AM/PM Fixed Line Installation Fees = RM50.00 Fixed Line Relocation Fees = RM50.00
Relocation Date* 2. Time: AM/PM Broadband Installation Fees = RM88.00 Broadband Activation Fees = RM75.00
3. Time: AM/PM unifi Installation Fees = RM200.00 unifi Relocation Fees = RM300.00
*Price displayed is exclusive of 6% Service Tax *Note: Fee will be charged in the bill

SECTION 4: BILLING
Online billing is available at www.unifi.com.my. Your bill will be sent to your preferred email*

Please tick if your email same as above

Please tick if you want paper bill (RM2.00/month)
Please tick if you would like to sign up for TM Autopay service (No more late payments. Skip the drive, skip the queue!)
Billing Address Please tick if same as installation address

Postal Code*

SECTION 5: SERVICE DETAILS

unifi
TM Fixed Line
unifi 300Mbps (RM199.00/month) Homeline (RM25.00/month)
unifi 100Mbps (RM129.00/month)
unifi 30Mbps (RM89.00/month)
unifi Basic 30Mbps (RM79.00/month)
TM Fixed Line
unifi Lite Commercial (RM89.00/month)
Others _______________________________________________ Keep both services (*Not applicable for VDSL2 customer)
Relocate to the following address for VDSL2 only
For Migration form Streamyx/unifi Lite to unifi (Subject to Broadband availability):
Login ID
Terminate Broadband after unifi is installed
Terminate Broaband and TM Fixed Line after unifi is installed
Terminate Broaband and TM Fixed Line after unifi is installed
(Maintain Homeline number for unifi)
**VDSL2 is delivered to premises of 5 storeys and above.

Preferred Login ID (for Broadband/unifi Home)

1. 2. 3.
Add-Ons (Specific terms applicable for the relevant Add-Ons are available for viewing at www.unifi.com.my)
Call Plan (for unifi Home only) unifi TV Packages Security & Surveillance Enhanced Facilities
Voice STD20 Ultimate Pack CCTV 1 camera (RM99.00/month) International Call
Others: (RM60.00/month) CCTV 2 camera (RM119.00/month) Call Waiting
Aneka Plus Pack Add camera: Call Transfer
Call Plan (for Broadband and TM Fixed Line) (RM30.00/month) please specify Call Transfer on Busy
Ruby Plus Pack (RM30.00/camera/month) Call Transfer on No Reply
Voice Deal 38
(RM30.00/month) Caller ID Display
(RM38.00/month) Home Gadget Protection
Varnam Plus Pack Caller ID Restriction
Voice Deal 48
(RM 30.00/month) HGP 5 (RM15.00/month) Voicemail
(RM48.00/month)
Others: HGP 10 (RM25.00/month) (please tick to unsubscribe)
Voice Deal 68
HGP 20 (RM40.00/month) Others:
(RM68.00)
Pakej RM10 unifi Play TV Voice IDD
(RM10.00/month; applicable to
384 kbps and 512 kbps) Plan A - 2 devices IDD 10 (RM10.00)
Others: (RM5.00/month) IDD 20 (RM20.00)
Plan B - 5 devices IDD 30 (RM30.00)
(RM10.00/month) IDD 50 (RM50.00)

SECTION 6: CHANGE OWNERSHIP

Login ID New Owner
Current Owner Name of Applicant
Name of Applicant MyKad/MyPR*
MyKad/MyPR* I agree to accept services from the current owner and agree on the following:
I agree to surrender my TM Fixed Line/Broadband/unifi Home service(s) to the new customer subject a) That I have read, understand and agree to be bound by the Terms & Conditions which accompany
and agree on the following: the usage of TM products & services and any amendments made
a) That I have to pay all outstanding payment b) That the above information provided is true and correct
b) That I am subject to RM10.00 Change of Ownership fee c) That I will pay the subscription fee and any related charges at the prevailing rate
Signature of Current Owner Date / / Signature of New Owner Date / /
*Price displayed is exclusive of 6% Service Tax
SECTION 7: IMPORTANT ACKNOWLEDGEMENT (MUST READ)
General
Minimum Subscription Period (MSP) for unifi is twenty four (24) months and unifiTV pack is twelve (12) Free installation and activation applicable for standard installation only. If your premise requires
months respectively effective from date of unifi activation (each unifi packages or unifiTV packages will Non-standard installation or additional cabling, extra charges will be imposed by TM Contractor and
be referred to individually as (“Service"). is payable by the Customer in cash to the attending TM's appointed installer. This free installation
excludes charges imposed by external contractors for concealed wiring, wiring over the ceiling,
If customer terminates unifi Lite Service before the end of MSP, on top of the existing usage of the customized wiring, etc.
Service (where applicable), Customer is subject to a penalty of RM 350. However for other unifi package,
customer will be charged the accumulative remaining MSP balance of the unifi package fee (calculates A fee of RM200.00 shall be charged for inaccessibility to premises and/or deferment of installation
at the price before discount) AND the accumulative remaining MSP balance of unifi TV pack [unifi TV on the day of installation. Any changes or deferment must be made at least at 4 PM before the
packages price] x [number of remaining months]. appointment day. Any re-appointment is subject to time slot availability of TM’s installer.
A request by Customer to downgrade unifi TV Pack(s) from higher price package to lower price package TM will not provide telephone set for installation of new unifi Service subscription.
is subject to a downgrade fee of RM10 (one time charge). Subscription Period will be automatically
refreshed once Customer has migrated. A new Minimum Subscription Period will be imposed (refresh) upon any request for downgrade
/upgrade. For any upgrade or downgrade request that requires a visit by TM to customer’s premises,
The first bill of the Service will two (2) months' Subscription Fee (current and subsequent month) and an additional fee of RM200.00 will be imposed.
other charges as applicable. Notwithstanding the Service’s credit limit policy implementation, Customer
agrees that the relevant Service may be suspended by TM if payment under the first(1st) bill or under Upon termination of unifi Service, customer shall return the BTU to TM. Failure to do so, customer
any subsequent bill is not fully paid as and when it falls due. may need to pay RM500.00 to TM for the penalty.
Customer shall bear the cost for on-site support visit requested from TM at the rate of RM50.00 per Any unifi Service application is made without the verification of NRIC through a MyKad Reader,
visit. The charge is not inclusive of any materials or equipment replacement charges that the Customer Customer may be subjected to an upfront payment of RM100.00 (Malaysian Citizen), at TM’s
may be required to pay to TM. discretion. However, an upfront payment of RM 500.00 is applicable for customer who is a
non-citizen or a permanent resident of Malaysia. The upfront payment is payable within ten (10) days,
The Customer understands and acknowledges that the internet access speed for the Service may be effective from the date of Service Activation, failing which the account will be suspended. The amount
affected as a result of the following factors: (a) location of website where users may experience lower will be credited into the customer’s account and reflected in the customer’s bill. TM reserves the right
speeds from some international websites; or (b) capacity of visited web server, in that, some web to terminate the account in the event no advance payment is received within thirty (30) days from the
servers cannot cope with huge traffic demand from users or do not have enough capacity or where date of Service Activation. Upon termination, any partial payment received shall be deducted as part
download speed is restricted to ensure fair level of service; or (c) network congestion as a result of payment for the agreed liquidated damages, as set in the General Terms and Condition.
network maintenance or outages; or (d) running multiple applications simultaneously like using other
applications such as Peer-to- Peer like Bittorent; or (e) accessing internet through WiFi that will cause Each Service shall be subject to the updated terms & conditions and Privacy Notice of TM available
slow speed than by wire; or (f) operating system where some configuration of users’ operating system at https://unifi.com.my/lsds/assets/documents/privacynotice.pdf.
may slow down internet performance.

For any unsuccessful registration due to infrastructure non readiness, TM will keep the application form *Price displayed is exclusive of 6% Service Tax
(including personal data) up to 180 days. After 180 days, if the registration is still unsuccessful the
application will be automatically cancelled. Customer's Signature

SECTION 8A: PRIVACY NOTICE

By submitting this Application Form, you are providing personal information to TM.
only on a need to know basis with other TM subsidiary or agencies so as to serve you in the most efficient and
TM will be processing your personal information provided in this Application Form and/or further information effective manner. An example might be in terms of resolving or addressing complaints that require escalation
and data that may be required by TM either from you or from any third parties especially from credit bureau, to other TM Subsidiary or agencies.
banks, credit reporting agencies and other businesses that provide like information or reference agencies
from time to time. TM may disclose your personal information to the following parties for the purposes stated above:
• Respective Authorized TM partner who are involved in providing the Add-Ons;
The purposes of such processing would include: • TM’s service providers or agents who are involved in providing the services or goods provided herein;
• Assessing your application or continued provisioning of the services provided herein (whichever is applicable); • Third parties (including those overseas) who provide data processing services which shall include but not
• Finance operation including to verify and process payment, billing and billing enquiries; limited to authorized reseller, call centre, data centre, payment channel;
• Customizing advertisements and content on the website(s) and the sites of TM and its group of companies • Any credit reference agencies or, in the event of default, any debt collection agencies;
(for further information on the TM’s group of companies, please visit www.tm.com.my); • Any person, who is under a duty of confidentiality to which has undertaken to keep such data confidential,
• Responding to your enquiries; which TM has engaged to fulfil its obligations to you;
• Research purposes including historical and statistical purposes and analysis; • Any actual or proposed assignee, transferee, participant or sub-participant of TM’s rights or business; and
• General operation and maintenance of the services or goods provided herein including audit and its • Requestor for directory assistance via the Directory Assistance Service 103 which is provided as part of a
related website(s); regulatory requirement under the Required Applications Services.
• Matching any data held by TM or its group of companies relating to you from time to time;
• Provide you with regular communications from TM relating to the services or goods provided herein; Your personal information will not be disclosed to any unauthorized third party.
• Investigation of complaints, suspected suspicious transactions and research for service or goods You may opt-out from having your registered telephone number be made available via the Directory
improvement; and Assistance Service 103 by contacting us at help@tm.com.my or unifi.com.my/chat.
• In compliance with any regulatory, statutory or legal obligation which shall include but not limited to the TM may also disclose your personal information if required to do so by law or in good faith, if such action is
provisioning of Directory Assistance Service 103 as part of the Required Applications Services. necessary to (i) comply with any law enforcement agency requirement, court orders or legal process or;
By submitting this application, you hereby consent and authorise TM to process and verify any information (ii) protect and defend the rights or property of TM and its group of companies and their users.
about you from any third party, especially credit bureau or credit reference agencies, which TM may require If you would like to make any inquiries or complaints or request access or correction of your personal
in connection with your application for any of TM’s services and/or review of the existing account with TM. information or where you elect to limit TM’s right to process your personal information, you may contact TM
Such consent and authorization will extend to any information obtained from any of the account(s) presently Contact Centre or you can visit the nearest TMpoint. Any request of access of correction of personal data
maintained for you, any new application for any form of services rendered or goods provided by TM, such may be subject to a fee and also to applicable provisions in the PDPA. However, we reserve the right to
historical financial or credit records, data or information whether or not provided personally or by any other decline requests which jeopardize the security and privacy of the personal information of others as well as
sources relating to you which was collected, gathered, received, captured, compiled, secured and/or requests which are impractical or not made in good faith.
obtained by TM through or by whatever means or methods or forms.
We may review and update this Privacy Notice from time to time to reflect changes in the law, changes in our
The information as required herein (unless stated otherwise) is obligatory on you and failure by you to business practices, procedures and structure, and the community’s changing privacy expectations. The
provide any information as required may affect your application or the continued provisioning of the latest version of TM’s Privacy Notice will be made available at www.tm.com.my.
services provided herein.
I hereby confirm that I have read, understand and agree to accept and be bound by the Terms and Conditions
In the course of processing this application, your personal information may be shared where necessary and of this service and the Privacy Notice which accompany the usage of this service.

SECTION 8B: NOTIS PRIVASI

Dengan menyerahkan Borang Permohonan ini, anda akan memberikan maklumat peribadi kepada TM.
atas dasar perlu tahu sahaja dengan subsidiari atau agensi-agensi TM supaya anda boleh dilayani dengan
TM akan memproses maklumat peribadi anda yang diberi dalam Borang Permohonan ini dan/atau maklumat cara yang paling efisyen dan efektif. Contohnya, mungkin dari segi menyelesaikan atau menangani aduan
lanjut serta data yang mungkin diperlukan oleh TM sama ada dari anda atau daripada pihak ketiga terutama- anda yang memerlukan perhatian dan penglibatan daripada subsidiari-subsidiari atau agensi-agensi TM.
nya dari biro kredit, bank, ejen pelapor kredit dan perniagaan-perniagaan lain yang memberikan maklumat
sedemikian atau agensi rujukan dari semasa ke semasa. TM mungkin akan mendedahkan maklumat peribadi anda kepada pihak-pihak berikut untuk tujuan yang
dinyatakan di atas:
Tujuan-tujuan untuk pemprosesan ini adalah termasuk: • Rakan Niaga TM yang sah yang terlibat dalam menyediakan ‘Add-Ons’;
• Menilai permohonan anda atau meneruskan peruntukan perkhidmatan yang diberikan di sini (yang mana • Pembekal-pembekal perkhidmatan atau ejen-ejen TM yang terlibat dalam menyediakan produk dan/
berkenaan); atau perkhidmatan;
• Operasi kewangan termasuk untuk mengesahkan dan memproses pembayaran, pengebilan dan • Pihak ketiga (termasuk yang di luar negara) yang menyediakan perkhidmatan pemprosesan data yang
pertanyaan berkaitan bil; termasuk tetapi tidak terhad kepada reseller telah diberikuasa, pusat panggilan, pusat data, saluran
• Menyesuaikan iklan-iklan dan kandungan di laman web TM dan syarikat-syarikat kumpulan TM (untuk pembayaran;
maklumat lanjut syarikat-syarikat kumpulan TM, sila layari www.tm.com.my); • Mana-mana agensi rujukan kredit atau, sekiranya berlaku kemungkiran, mana-mana agensi pemungutan
• Menjawab pertanyaan-pertanyaan anda; hutang;
• Tujuan penyelidikan termasuk tujuan rekod dan statistik dan analisis; • Mana-mana orang, yang berada di bawah kewajipan kerahsiaan yang telah mengaku janji untuk
• Ooperasi umum dan penyelenggaraan perkhidmatan-perkhidmatan atau barang-barang yang diberikan memastikan data tersebut disimpan secara rahsia, yang telah dilantik oleh TM untuk memenuhi
di sini termasuk audit serta laman-laman web yang berkenaan; tanggungjawabnya kepada anda;
• Pemadanan apa-apa data yang disimpan oleh TM atau syarikat-syarikat kumpulan TM yang berkenaan • Mana-mana pemegang serah hak yang sebenar atau yang dicadangkan, penerima pindahan, peserta atau
dengan anda dari semasa ke semasa; sub-peserta hak atau perniagaan TM ; dan
• Menyediakan komunikasi yang kerap dari TM kepada anda untuk perkhidmatan atau barangan yang • Pemohon untuk bantuan direktori melalui Perkhidmatan Bantuan Direktori 103 yang diadakan sebagai
diberikan di sini; sebahagian daripada keperluan kawal selia di bawah Perkhidmatan Aplikasi Dikehendaki.
• Penyiasatan aduan, transaksi-transaksi yang mencurigakan dan penyelidikan untuk pembaikan
perkhidmatan dan barangan; dan mematuhi mana-mana obligasi kawal selia, statutori atau Maklumat peribadi anda tidak akan didedahkan kepada mana-mana pihak ketiga yang tidak berautoriti.
undang-undang yang termasuk tetapi tidak terhad kepada penyediaan Perkhidmatan Bantuan Direktori Anda boleh memilih untuk keluar daripada mempunyai nombor telefon berdaftar anda tersedia
103 sebagai sebahagian daripada Perkhidmatan Aplikasi Dikehendaki. melalui Perkhidmatan Bantuan Direktori 103 dengan menghubungi kami di help@tm.com.my atau
Dengan menyerahkan permohonan ini, anda dengan ini mengizinkan dan memberi kuasa kepada TM untuk unifi.com.my/chat.
memperoses dan mengesahkan apa-apa maklumat mengenai anda daripada pihak ketiga, terutamanya biro TM boleh mendedahkan maklumat peribadi anda sekiranya dituntut oleh undang-undang atau jika perlu
kredit dan agensi rujukan kewangan yang mungkin dikehendaki oleh TM yang berkaitan dengan pemohonan sahaja, untuk (i) mematuhi kehendak-kehendak agensi penguatkuasaan undang-undang, perintah
anda untuk mana-mana produk dan/atau perkhidmatan TM dan/atau semakan akaun anda yang sedia ada mahkamah, ataupun proses undang-undang ataupun; (ii) melindungi dan mempertahankan hak dan
dengan TM. Keizinan dan pemberian kuasa akan dilanjutkan kepada apa-apa maklumat yang diperolehi hartatanah TM serta syarikat-syarikat kumpulan serta pengguna-penggunanya.
daripada mana-mana akaun sedia ada anda pada masa ini, apa-apa pemohonan baru untuk apa jua bentuk Jika anda ingin membuat apa-apa pertanyaan, aduan, meminta akses, pembetulan maklumat peribadi atau
perkhidmatan atau produk yang diberikan oleh TM, rekod sejarah kewangan atau kredit, data atau maklumat jika anda memilih untuk menghadkan hak TM untuk memproses maklumat peribadi anda, anda boleh
sama ada dibekalkan oleh diri sendiri atau daripada sumber-sumber lain yang berhubungan dengan anda yang menghubungi Pusat Panggilan TM atau anda boleh melawat TMPoint yang terdekat. Mana-mana
telah dikumpul, diterima, diambil, disusun, didapati dan/atau diperolehi oleh TM dengan apa jua cara atau permintaan akses untuk pembetulan maklumat peribadi mungkin tertakluk kepada fi dan juga peruntukan
kaedah atau bentuk. yang terpakai dalam PDPA. Walau bagaimanapun, kami berhak untuk menolak permintaan yang menjejaskan
Maklumat yang dikehendaki di sini (kecuali dinyatakan sebaliknya) adalah wajib dan kegagalan anda untuk keselamatan dan privasi maklumat peribadi orang lain serta permintaan yang tidak praktikal atau tidak
memberikan maklumat yang diperlukan mungkin akan menjejaskan permohonan anda atau meneruskan dibuat dengan suci hati.
permasangan perkhidmatan yang diberikan di sini. Kami mungkin akan mengkaji semula dan megemaskini Notis Privasi ini dari semasa ke semasa untuk
Semasa memproses permohonan ini, maklumat peribadi anda mungkin akan dikongsi di mana perlu dan hanya mencerminkan perubahan dalam undang-undang, perubahan dalam amalan perniagaan, prosedur dan
struktur, dan perubahan dalam jangkaan privasi masyarakat. Versi terbaru Notis Privasi TM boleh didapati
di www.tm.com.my.

SECTION 9: DECLARATION & ACKNOWLEDGEMENT SECTION 10: FOR TM USE ONLY

I hereby declare that I wish to subscribe for the service provided by TM. I hereby certify that the above
information provided is true and correct. I have read, understand and agree to be bound by the Terms Processor
and Conditions which accompany the usage of TM products & services and any amendment made Name
thereto. I hereby consent to the collection and processing of my personal information in accordance to ID
the Privacy Notice. Date / /

TMpoint/Reseller
Reseller ID
Agent ID
Reseller’s Name
*Mandatory Field
Signature of Applicant Date / /
Date / S rvice Activation Date / /

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