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USER INFORMATION
NAME (As per passport) :
PASSPORT NUMBER :
NATIONALITY :
CONTACT NO. :
EMAIL ADDRESS :
NAME OF COMPANY :
RENTAL INFORMATION
COLLECTION DATE : _____ (DD)_____(MM)________(YYYY)
COLLECTION TIME : __________ hrs
COUNTRY VISITING Australia China Macau Hong Kong
(Router is country Indonesia Japan Malaysia Philippines
specific. Holding 2 South Korea Taiwan Thailand Vietnam
devices will incur U.S.A Russia Others:
double charge) Europe : ________________________________________
(Please specify the countries for Europe plan)
Insurance: I would like to opt in for Additional Wifi Insurance coverage at SGD$10
For any loss or damage to the wi-fi router and/or accessories upon your return, the following replacement
fees shall apply:
If more than 01 Router inputs under remarks.
Remarks:
$300 Wi-Fi Router
$50 Power Adapter
USB Charging Cable
$25 Pouch
____________________________________
Signature / Date