Sign Up Form

    Sign Up / Registration
    2. Residential Plan
    3. Business Package
    4. Company Name
    5. Business Registration Number

    6. Company SSM Document
      For Trading / Enterprise: Form D, Form A, Form B
      For Sendirian Berhad /Berhad: Form 9, Form24, Form 49


    7. Full Name
    8. NRIC No./Passport No.:
    9. Mobile No.:
    10. Email Address
    11. Full Address
    12. Postcode
    13. State
    14. Nationality
    15. Upload Your Identity Card (Front):
    16. Upload Your Identity Card (Back):
    17. Upload Visa Card - Non-Malaysian (Front):
    18. Upload Visa Card - Non-Malaysian (Back):
    19. Agent ID - GAbi Team (Leave blank if not sure)

    20. Document & Declarations

      Photocopy of MyKad (front and back) or passport for Non-Malaysian (minimum 12 months validity) and visa (minimum 6 months validity)I hereby consent to the collection, use, disclosure of my personal information in accordance with the Privacy Policy available on www.citybroadband.my.I hereby declare that the above information, documents, and any appendices attached are true and valid. I have read and understood the contents of this form and agreed to be bound by Terms & Condition as stated on the next page of this form which accompany the subscription of product(s) and/ or service(s). 18C Master Sdn Bhd reserve the rights to refuse any application at any given time should any of the information is incorrect.

    21. Your Signature:

    Click to Chat!