Applicant Name: *

Applicant New IC Number: *

Address: *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Mobile Number: *

E-Mail Address: *

Select YES Prepaid Package:

Select YES Postpaid Package:

Preferred Login ID:
(For Personalised ID Only. Provide 6 to 16 Character)

Preferred YES Mobile Number:
(For Personalised ID Only. Provide 4 Digits Number)

Upload Applicant IC:
(Front & Back) *

For Maybank2U, please click Maybank2U Pay icon to make the Upfront Payment:

Upload Payment Slip:

Remark:

Agent ID / Name:
(For Agent Only)