PREPAID CUSTOMER REGISTRATION FORM
‘Borang Pendaftaran Pelanggan Prabayar
Cows taru
1 nin Pty seman tar Honor
: porter
‘SM Seal Number /Nember St Slt
EEC e RSE Fae e eer)
Name (as NFIG/ Passport / Nara ang KP /paspor9
(Oy merece] mesox ones aintin
spray ce the ated dagen
teeta tame rd Corser ot he Seca ated
‘aos arash wth a a
san marantnon boar sa mgt a rr
rarer oa rasan Sat sarinjry aera
(er Bs geen ee dito ch
‘msn sec na i rarer Amman ge
aman ni
Sonar Targa
owes CO OO
DO MM YY
}
Natoelty erpaegee
ain ayaa
[71 Neelasian /Bukan Warganegere
sew NCH Ba
ee re a fe fees
DD omterxrtame
lites eer
[Ey Petow or Amy 0 “KP Pols ta Tonio
[Dy Werke remit ke
SEEEESEEEEEP EEE)
ower § C/O
Tank Lane +
TE menrtaett — ] Foie Porerin
‘ens (Abert
Desir Simp / Cap Penge
vert a fort. Sasa ape be tary Paes
corer soe rect Beas rn pauroun 3 ha ah
Term Sy prc
‘asl Satie /TanctrgenPengacar
Doale Code Koa Pongo
owermen COO
DO MM VY
Proceed by/Oprcans oleh
owes C0070
DD MM VY
Site Neger Postcode Posted
mame!
Comments / Kamen
Gh Back No 2 ta PWU 7A Ca Gia Oana Darran 720i Png a Soar