! "#$%&' () *+, - Cib Net Station (.

/
Please fill in the details correctly and carefully so that CiB Net Station customer services crews can keep contact
with you. Kindly ensure the integrity and legal ownership of the details. If there is any illegal detail or impersonation case
found, this application form will deemed to e invalid, and will N!" e accepted y CiB Net Station officials.
a
Player's Information
0
Name # &1$ %uhammad "aufi& Bin Shamsul
Contact Numer # $ '()**++*',
-.mail /ddress# 234$ terla0ur0arak1yahoo.com
No. IC # 56 7 $ 22'3(4.'4.,2+(
5ate # 89$ **#,#*'(3
Subject
:
6 no 7 8ost Item # ;<= 6 yes 7 9eset Password # > ?
6 no 7 Change 5etail # @A 6 no 7 Stolen /ccount # 7BC
6 no 7 !thers # DE$
Game Account
Information
7
CiB%all I5 # CiB%all 7$
:4rius
;ame /ccount # 7$
:4rius
;ame "itle # F$
%/"
Server # $
Server II
Character name#F$
Naila<5
GH I / Detailed Descriptions of Problem
( 7BC JK L $ MN$OC<=&FPQ<=R $ST
(Please specify the date and time / detailed situation/ the title and category of equipment / other significant information.)
UVW 56/X/ YLT
=Please attach the front side of Identity Card#5riving
8icense#Student Card>
?Please ensure that oth sides are clear.
* Z[\] ^_
U`W 56/X/ YLT
=Please attach the back side of Identity Card#5riving
8icense#Student Card>
?Please ensure that oth sides are clear.
* Z[\] ^_
0 (Official use only)
ab c./ / d b
CiB / Player's Inquiry orm
7 / Case Reference!!!!!
("# / Official use only)