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    Termination Form

    Uploaded by

    MF L

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Termination Form

    Uploaded by

    MF L
    4 views2 pages

    Copyright

    © © All Rights Reserved

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    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    4 views2 pages

    Termination Form

    Uploaded by

    MF L

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    SERVICE TERMINATION FORM

    IMPORTANT: PLEASE READ THE TERMS AND CONDITIONS AS PRINTED IN THE SUPPLEMENTARY SERVICE AGREEMENT
    (SSA) BEFORE COMPLETING THIS SERVICE ORDER FORM. APPLICATION MUST BE MADE BY AUTHORISED PERSONNEL
    OF THE COMPANY.

    SECTION A: PARTICULARS OF SUBSCRIBER


    Full Name (as per NRIC/Passport)/Company/Firm’s Name*
    NRIC* Passport No.*
    (Malaysian citizens, please enclose a copy of NRIC) (Non-Malaysian citizens, please enclose a copy of Passport)

    Installation Address*

    Postcode* City* State*

    Corresponding Address*

    Postcode* City* State*


    Mobile No.* Home Tel. No.
    Office Tel. No.
    Email*
    *Mandatory Field

    SECTION 2: PRODUCT AND SERVICE DETAILS


    Contract Terms:
    12 Months (1 Years)
    24 Months (2 Years)
    36 Months (3 Years)
    48 Months (4 Years)

    Important Notes : Termination fee of RM500 is chargeable for termination of


    service within the contract period.

    SECTION 3: ACCOUNT DETAILS


    Money returning purpose

    Account Holder Name:


    Bank Name:
    Account Number:

    SECTION 3: EQUIPMENT AND MATERIALS


    Standard equipment returned in the packet
    ONT
    Residential Gateway (RG) /
    Business Gateway (BG)
    DECT Phone
    Fibre Wall Socket
    Phone Wall Socket

    i. Customer’s confirmation on termination of service and any equipment and services required are provided in this form. Upon customer’s acceptance of the
    work order thereunder, additional terms and conditions thereof shall be deeemed incorporated as part of the terms and conditions of the Symphonet
    service.

    ii. All equipment returned to Symphonet is in a good condition or such other reasonable sum as may be determined by Symphonet as a penalty.
    SECTION 4: TERMS AND CONDITIONS OF SERVICE TERMINATION
    By singing this Symphonet Service Termination From, I/We, [Customer/Authorised
    Representative of Customer named in this Service Acceptance Form], New I/C No. Company No./Business
    Registration No. [ ] hereby acknowlegde and agree that :

    I/We hereby confirm and acknolegde that I/we have read and understood the Acknowledge and Term and Conditions contained I
    this Service Termination Form. I/We agree to be bound by all such Terms and Conditions and confirm that the information given
    herein is true, current and correct.

    Date :
    Customer’s/Authorised Representative’s Signature

    SECTION 5: FOR SYMPHONET USE ONLY

    Customer ID :
    Termination Date : Time :
    Reseller Representative :

    Reseller Representative’s Signature Company’s Stamp

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