Pease tick YA. communiaton Sn Bh (ne Overt Pes, Not alin Hang tek, Si an SCOR CENSOR Submision Date] 27 AUGUST 2018 a Fe | KANKGIRALOG MPRA 1D (MyKad/ Passport) 780706-05-5469 [Contact Number |__016-6039378 Email Address kevinraaj@yahoo.com 18] ACCOUNT DETAILS = fons = ae Tae ‘Yes Number 018-5859378 LYes Account Number | 812469627, (C] SAC OFFER ACCEPTANCE | rr rheee— 1 Sinden are earn) etaors other ds llalso confirm and decare that | have read, understood and consented to the terms below fo extending/re -contracting applicable ‘only if picked “Free Device + Extra Dala") Customer Signature: Teave section (and [E] Bank ifconsento section (C7 [OJ ACCOUNT CLOSURE. a Reason for Nt Satisfied with Package - Pricing Better Offer from Other Telco ‘Account Closure [5] Not Satisfied with Package - Data Tonnage imax 5] Not Satisfied with Package - Data Speed Celcom (please tick one) 5] Not Satisfied with Customer Service Bois = Connectivity issue Ci uMobite Moving Out of Area / Overseas Pi/Webe Device Faulty ‘TM Streamyx /Unifi T Registered Another Line wth Yes TE DECLARATION Postpaid ‘Llundentand and agre that the service wil be terminated on the submission dt ofthis closure account request lagreet hat am able for any and “ilwumsemaning outstanding in my account Including the Commitment Fee prorated untlthe termination dte| shal alo be liable for any eary {termination charges applicable, In accordance wth the terms of my subscription. _understandand agree that ny deposta mount Gf any) wl be Used to offset any outstanding balance (cluding any payments, charges fee whatsoever sll omng under fy lst blo the test il for my aecount, whether or not such bill hasbeen sued and/or generated a tthetime of his request. 3. mthe event my deposits insfcen to settle such outstanding sums, ageeto make payment of any shortfall and set le the samein accordance wth ‘my obligations unde the terms of my subscrigton. ‘inthe matter of quatifeation agree that the sums tatedin my final il shall be conclusive proof ofthe sum owingloutsanding TiPrepaid ‘Lamfulyavare that upon closure of my account any rebate balance and/or remaining or unutlized creat wl be fret. Tefund betas (Postaiony) Care aoe CIMB BANK BERHAD - SAVING ACCOUNT teres any fund hen ‘amount hall be made acne! Bank Account Number Hee aed ‘Customer’ Signature i z THLFOR OFACEUSEONTY a Bill Cycle Tots 7 113 116 tot 22 Fas Fe Contract Period TTNaked TZmonths 2émonths | Others: Estimated Early Termination To Charges Yes___:___Remaining Month(s) X RM__ Monthly Fee=_ RM Bundle Device Device return: (stil under contract) CNo Yes, specif DeviceCondition =[)Good [Faulty Serial Number Mac 1D: Collected Sum ffany) Ra Yes Store Date ‘Accepted BY Time Service Request GR) No