AMCP/AIC/08

ASIA MOBILE COMMERCE PRIVILEGE (M) SDN BHD (618758-H)

C1-1, Dataran Palma Ampang, Jalan Selaman 1,
68000 Ampang, Selangor Darul Ehsan
Tel: 603-4270 2703 Fax: 603-4270 2723

CHANGE IN MOBILE PHONE NUMBER

Full Name (As in NRIC/Passport): ……………………………………………..

NRIC: ……………………………………………..
Correspondence Address: ……………………………………………..
……………………………………………..
……………………………………………..
Tel. No.: (O) …………………. (H) ………………
Direct Upline’s Name: ……………………………………………..
Direct Upline’s Mobile Phone No.: ……………………………………………..

Current Mobile Phone No.: ……………………………………………..

New Mobile Phone No.: ……………………………………………..

Balance In Prepaid Account:

2 to 19 PP 40 to 59 PP 80 to 99 PP

20 to 39 PP 60 to 79 PP 100 PP and above

Signature of Mobile Agent: Date:

…………………………… …………………..
Note: Please be informed that MyMode will automatically deduct 2 PP from your
prepaid account as service charge. All changes in mobile phone number will
have to be forwarded with the mobile phone owner’s photocopy of NRIC.
Agents are strictly FORBIDDEN from reporting change in mobile phone number on
behalf of others.

FOR OFFICE USE

Checked by:
………………………….
Name:
Date: