JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Application Form
Helping you to register Streamyx/UniFi/Maxis =D
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Type of Application
*
Choose
New (UniFi)
New (Streamyx Only)
New (Fixed Line + Streamyx)
Upgrade
New (Maxis)
Current Package
For UPGRADE only
Your answer
Full Name / Company Name
*
Your answer
Packages
*
Choose
UniFi Advance 30Mbps + Jumbo Lite + Discount RM60 for 24 months (Bonanza Campaign) @ RM139
UniFi Advance Plus 50Mbps + Jumbo Lite + Discount RM60 for 24 months (Bonanza Campaign) @ RM189
UniFi Biz Advance 30Mbps BIZFEST 2017 @ RM279
UniFi Biz Advance 50Mbps BIZFEST2017 @ RM329
UniFi Biz Lite 10Mbps (Bonanza Campaign) @ RM199
UniFi Biz Pro 100Mbps + Discount RM50 for 24 months (Bonanza Campaign) @ RM349
UniFi Lite 10Mbps + Aneka (Q2 2017 Campaign) + Voice 20 @ RM149
UniFi Lite 10Mbps + Jumbo Lite (Bonanza 2017 Campaign) @ RM129
UniFi Lite 10Mbps + Jumbo Lite (Q2 2017 Campaign) + Voice 20 @ RM149
UniFi Lite 10Mbps + Ruby (Q2 2017 Campaign) + Voice 20 @ RM149
UniFi Lite 10Mbps + Varnam (Q2 2017 Campaign) + Voice 20 @ RM149
UniFi Pro 100Mbps + Jumbo Lite + Discount RM90 for 24 months (Bonanza Campaign) @ RM239
UniFi Advance 30Mbps + Jumbo Lite + Discount RM60 for 24 months (Bonanza Campaign) @ RM139
Streamyx 1Mbps [RM110/month]
Streamyx 2Mbps [RM120/month]
Streamyx 4Mbps [RM130/month]
Streamyx 8Mbps [RM140/month]
Maxis Home Fibre Internet 10Mbps [RM119/month]
Maxis Home Fibre Internet 30Mbps [RM139/month]
Maxis Home Fibre Internet 50Mbps [RM219/month]
Maxis Home Fibre Internet 100Mbps [RM299/month]
Maxis Business Fibre Internet (Dyanmic IP) 20Mbps [RM208/month]
Maxis Business Fibre Internet (Dynamic IP) 32Mbps [RM258/month]
Maxis Business Fibre Internet (Dynamic IP) 64Mbps [RM358/month]
Maxis Business Fibre Internet (Dynamic IP) 100Mbps [RM398/month]
Maxis Business Fibre Internet (Fixed IP) 20Mbps [RM408/month]
Maxis Business Fibre Internet (Fixed IP) 32Mbps [RM458/month]
Maxis Business Fibre Internet (Fixed IP) 64Mbps [RM558/month]
Maxis Business Fibre Internet (Fixed IP) 100Mbps [RM598/month]
IC Number
*
Your answer
Contact No.
*
Your answer
Email Address
*
Your answer
Installation Address
Street Address
Your answer
Type of Property
Landed (Terrance, etc)
High Rise (More than 5 storey)
Clear selection
Existing Streamyx Login ID
For UPGRADE only
Your answer
Existing Home Phone Number
For UPGRADE only
Your answer
Keep Existing Line & Number?
Yes (RM25/month)
No
Clear selection
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report
