Service Request Form

A. SUBSCRIBER'S INFORMATION

Full Name (as in NRIC):

Mobile Number: - NRIC / Passport No.:

B. CHANGE OF DETAILS

*please attached photocopy of IC for verification purposes

Full Name (as in NRIC):

Contact Number: - NRIC / Passport No.:

Email Address :
New Corresspondence Address:

City / State: Postcode:

C. CHANGE OF PLAN

* For any upgrade / downgrade plan, it will effective on next billing cycle

Your current ONEXOX BLACK plan:

B10 B39 B59 B89 B149

Change to ONEXOX BLACK plan below:

B10 B39 B59 B89 B149 ONEXOX PREPAID

D. BILL METHOD

PRINTED BILL

Address :

City / State: Postcode:

E-BILL

Email Address :
E. REACTIVATION / REINSTATEMENT
REASON :

* Documents required : proof of payment / bank-in slip of the advance payment based on the plan subscribed

F. MNP PORT FAILED REFUND

* Refund of the advance payment due to MNP rejection, cancellation, unsuccessful or withdrawal of the porting request.

Name of Account Holder :

Name of Bank:

Bank Account No.:

G. TERMINATION / MNP PORT OUT
TERMINATION MNP PORT OUT
DECLARATION & SIGNATURE
I / We declare that all the above information given is true.

I / We have read, understood and agreed to be bound by all the Terms & Conditions.

I / We agree to provide additional information/documentations when requested by XOX

I have read & agree on ONEXOX BLACK 's Terms & Conditions, Please complete & return form to:

XOX Mobile Sdn. Bhd.

XOX Customer Careline: 1300-888-010
Email: channelsupport@xox.com.my
Subscriber's Signature Date