MOBILE POSTPAID CHANGE RATE PLAN FORM

A. CUSTOMER INFORMATION

Full Name Mr. MOHD HAFIZUDDIN BIN MAT SHOIB Gender Male
ID Card Type New IC ID No 900623126181
DOB 23/06/1990 Language English
Nationality MALAYSIAN Email hafizuddinmatshoib@gmail.com
Contact No 60135434222 Account Bill Cycle 7
Biometric Verification Yes

B. ADDRESS

Address LOT 94, POS KOMUNITI

KAMPUNG JAYA BAKTI
Postcode 90100
Town/City Name Beluran
State/Province Sabah

C. ORDER DETAILS

Plan Details :
MSISDN 60198098434
SIM Serial Not Available
Plan Mobile MaxisONE Share 188 - 01 Mandatory
Package
VAS
Mobile - eBill Waiver - RM0.00
Mobile - 100% SafeDevice Rebate (3 months
subscription fee) - RM0.00
Mobile - Access International Roaming - RM0.00
Mobile - 3G Video Telephony (RM0.00)
Mobile - SafeDevice (RM3,001 - RM4,000) -
RM33.00
Mobile - Short Message Service (MO) - RM0.00
Mobile - Telephony - RM188.00
Mobile - WAP - RM0.00
Mobile - Access IDD Calls - RM0.00
Mobile - Bill Itemised - RM10.00
Mobile - Call Hold - RM0.00
Mobile - Call Waiting - RM0.00
Mobile - CLIP-Caller Line Id Pres - RM0.00
Mobile - Family Plus Free Talktime and SMS -
RM0.00
Mobile - MMS Service Package - RM0.00
Mobile - Mobile Internet 60GB Monthly share -
RM0.00

Summary Details :
Registration ID 8876552
Account Number 2171880160

TOTAL PAYABLE (RM) 0.00

**Price May Be Subject to Service Tax.**

Bill Delivery Details :

Deliver via Email - It's totally FREE!
Deliver eBill to hafizuddinmatshoib@gmail.com
SMS Notification Yes
Mobile Number 60198098434
Payment Mode Cash
D. DECLARATION

(a) I/We hereby declare that I/we wish to subscribe for the Services provided by Maxis Broadband Sdn Bhd.
(b) That the above information provided is true and correct.
(c) That I/we have read and agree to be bound by the contract terms herewith and all other terms & conditions printed and/or attached hereto
and any amendments made thereto.
(d) that I/we hereby consent to the collection and processing of my personal information in accordance with the Maxis Privacy Statement (at
www.maxis.com.my/pdpa). I/we further agree and accept that the terms and conditions in the Maxis Privacy Statement forms an integral part of
the terms and conditions for use of the Services.

___________________________________________________________________
Applicant's Signature
Date: 28/01/2020 03:19:03 PM

E. FOR OFFICE USE ONLY

Sales Code - Dealer Outlet Maxis Centre Sandakan (EASTM.00013)

Sales Staff Code HAZIMAHD (EASTM.00013)