Date: Company Stamp

Celcom Mobile Sdn. Bhd.

Dear Sirs/ Mdms,

LETTER OF REQUEST & AUTHORIZATION for CELCOM MOBILE REGISTRATION

With reference to your offer, we would like to confirm our acceptance of the following application under the CELCOM SMB Account.

Service Application

New SME Account Add New Line(s) on Existing SME A/C: Mobile No. Portability (MNP)

Rate Plan No. of new lines No. of Conversion No. of Portability Contract Period
lines lines
First Platinum Plus 188
First Platinum 148
First Gold Supreme 128
First Gold 98
First Gold 80
First Blue 38+CUG
Power 28 Plus
Power 48 Plus
Power 98 Plus
Power 148 Plus
Box S/M/L
Box Member
Addon

Others – Data @ _____________

Total Lines:

Total Commitment Per month

We would also like to activate the below Mobile Number for Roaming services.
Selected Mobile Number:

Authorized Person In-Charge (PIC) - if applicable

Signatu
Person In-Charge (PIC) Name: re:
NRIC: Designation:
Contact No. (Office): Mobile No.:

Customer Declaration

I/We hereby agree to be bound by the terms and conditions contained in the Celcom Mobile Registration Form together with the Addendum &
Appendix as provided and/or any further addendum & appendix, supplemental, variation and/or modification of the terms and conditions. I/We
hereby authorize the person named above (if any) to accept the offer and execute the necessary documents for affecting this transaction and future
dealings with Celcom Mobile Sdn. Bhd. for and on behalf of the Company unless the authorization is retracted by the person named above (if any) or by
the Company’ Director by written notice.

Thank you.
Yours sincerely,

Signature:
Authorized Signatories:
NRIC: Company Stamp
Designation:
Company Name:
Date: