es "ACCOUNT CLOSURE REQUEST / SAC OFFER ACCEPTANCE FORM, Suboraion Date T [A cusToMeR DETAILS Full Name (as per ID) Mura mAD EMiPacC A] @ An AO FeuciO] 10 (MyKad / Passport) G2\o\\- tp - SEF | Contact Number Lo -t 3€300 Ema Address ‘Luaivalgyawm| a> Oqavoo- cov [Te] account oeTals ‘Account Di Posipaid Lireepa YesiD ores Yes Number oe [ex Acount Number ———] {C1 SAC OFFER ACCEPTANCE Pick ne (i) _[] Fee Device Entra Data G6 (ended [Re-Conoct-12 months) Tira Data — 68 without contrac} Cosi waiver | Tlvfereby confirm and declare that | wish to sign up forthe SAC offer that was offered to me by YES 4G and agree to continue to use the Service Dit aco confirm and declare that | have read, understood and consented to the terms below for extending/re-contracting. (applicable only if picked Free Device +£xtra Data (Extended /Re-Contract ~12 months} Customer Signature: eave section [D] and [é] blank if consent to section [C] (Di tensccounrcrosme Reason for TL Not Satisfied with Package - Pricing ‘Li Better offer from Other Telco ‘Account Closure Not satisfied with Package - Data Tonnage Maxis CZ Not satisfied with Package - Data Speed CO celeom (please tick one) BNot satistied with Customer Service Doici Ci connectivity issue Qu mobite Moving Out of Area / Overseas Qe. D1 bevice Faulty COM Streamyx / Unifi [Elegistered Another Line with Yes ECARATION Postpaid {Tl agree that | am lable for any and all sums remaining outstanding in my account. lam fully aware that | would stil be charged the ‘commitment fee for the entire Biling Cycle in which the termination occutred, and would be liable forthe charges in accordance with the terms of my subscription (including, but not limited to, the early termination charges if applicable), 2 understand and agree that my deposit amount (f any) wil be used to offset any outstanding balance (including any payments, charges, fee whatsoever) still owing under my last bil or the lates bil for my account, whether ornot such illhas been isued and/or generated as the time ofthis request. 3 In the event my deposit insufficient to settle such outstanding sums, lagree to make payment of any shortfall and settle the same in ‘accordance with my obligations under the terms of my subscription, 4: in the matter of quantification, | agree that the sums stated in my fna bil shall be conclusive proof ofthe sum owing/outstanding. | LDiPrepaid {Elam fully aware that upon closure of my account, ny rebate balance and/or remaining or unutlzed credits wil be forfeited. Refund Details sire (ostpoid only) Bank Name tt there s any refund, then | Bank Account Number amount shall bemade [TJ cheque payable to me a: Mailing Address = Note: would take o longer processing time ‘Custom? Signature THIFOR OFFicE USE ONY ill Cycle 1 U3 D7 20 C3 Chis C19 O22 C25 Ths (Contract Period Naked ‘2 months ‘24 months ‘Other Estimated Early Termination Tne Charges ives __:_Remsining Month(s) X RM_ Monthly Fee »RM_ ‘Bundle Device ‘Device return: (if stil under contract) Ono Dives, specify: Device Condition :-]Go0d [Faulty Serial Number Mac Collected Summ ifany) i ‘Yes Store Date. ‘Accepted By Time. Service Request (SR) No