SME Digitalisation Grant 2020

Registration Form
Please write in capital letters and tick ( ) where applicable.
A. Type of Segment
Corporate SME

B. For Existing Customer C. For New Customer

Account Details Documents Required
Company Name: For Corporate/Company: *To be certified with company stamp

Account No.: Letter of request/authorisation on official letterhead*

Photocopy of authorised signatory’s NRIC (both side) or Passport (Non-Malaysian)*
Existing Mobile No.: -
Photocopy of authorised Company Registration documents*
D. Company Details *Required
Company Name as per Company Form*: Authorised Signatory’s Name*:

Business Registration No.*: Authorised Signatory’s NRIC/Passport No.*:

Nature of Business*: Person-in-Charge (PIC) Name*:

Financial Services & Insurance Manufacturing, Agriculture & Mining PIC Contact No. (Mobile)*: -
Retail and F&B Education
PIC E-mail at work*:
Hospitality Property & Construction
Alternate PIC Name*:
Logistic & Transportation Trading, Reseller & Distribution
Alternate PIC NRIC/Passport No.*:
Services & Professional Services Energy and Utility
Alternate PIC Contact No. (Mobile)*: -
IT and Communications
Alternate PIC Contact No. (Company)*: -
No. of Employees*:
Alternate PIC Fax No. (Company)*: -
Annual Company Sales Turnover*:
Alternate PIC E-mail at work*:
<RM300,000 RM15mil - <RM20mil
Billing Preference: Existing Billing Account No.:
RM300,000 - <RM3mil RM20mil - RM50mil
New Bill
RM3mil - <RM15mil >RM50mil
Sign up for Direct Debit payment
Note: You will be automatically registered for Business Hub upon activation of the subscribed Services at no extra cost. An email verification will be sent to the Authorised Signatory or PIC who is required to activate the
account to be able to access the Business Hub portal to view and download the electronic bill statements. A fee of RM10 per month (exclusive of all applicable taxes) will be applicable for any request for printed itemised
bill to be delivered to you.
E. Billing & Delivery Details *Required
Company Billing Address* :

Postcode*:
City* : State* :
Delivery Address* :

Postcode*:
City* : State* :
Primary Contact Details (Required)
Primary Contact Name* : Primary NRIC/Passport No.* :
Primary Contact No. (Mobile)* Primary Contact No. (Fixed No.)*
(can be reached no.): - (can be reached no.): -

Primary Contact Email*:

Secondary Contact Details (Optional)
Secondary Contact Name: Secondary NRIC/Passport No.:

Secondary Contact No. (Mobile): - Secondary Contact No. (Fixed No.): -

Secondary Contact Email:

Delivery Authorisation For 3rd Party Collection

I, undersigned, hereby authorise (Name), (NRIC/Passport No.),
- (Mobile Contact No.), - (Fixed Contact No.), to collect my/our mobile device(s) overleaf, and accompany
SIM Card(s) (where applicable), on my/our behalf. I am aware that risk will be passed to the authorised person designated to collect the device and SIM Card herein and absolve Maxis from any and all liability
upon collection.
Company’s Stamp

Authorised Signatory’s Signature

Name:

NRIC/Passport No.: Date (DD/MM/YY):

Designation:

Delivery in Klang Valley

For purposes of security, you are required to verify your identity by biometric (i.e. fingerprint) authentication with your valid and working identity card at the point of delivery. We reserve the right to not release the Mobile
Device and/or Mobile Equipment in cases of your failure and/or refusal to verify your identity.
F. Transfer of Ownership

I hereby agree to transfer my SIM and Mobile number(s) - to the authorised signatory hereto.
Name:

NRIC/Passport No.:
Date (DD/MM/YY):
Note:
Transferor’s Signature Must attach a photocopy of Transferor’s NRIC front and back in the same page.
February 2021 Page 1 of 9
SME Digitalisation Grant 2020
Registration Form
G. Service Package *Required

Maxis Business Postpaid Package Please Select One (If Applicable) Postpaid Postpaid & Fibre MaxisONE Go WiFi Others

Line 1 Line 2 Line 3 Line 4

1 User’s Name

2 Mobile Number

3 Type of Service*
(New/pre-to-post/port-in/renewal/conversion)

4 Type of Line (For FlexiShare only) Individual or Company Individual or Company Individual or Company Individual or Company
line line line line line line line line

5 Rate Plan

6 Zerolution Monthly Fee

7 Data Package/Additional Data

8 Contract Term (Months) Voice Data Voice Data Voice Data Voice Data

9 Device Model

10 Itemised Billing Yes No Yes No Yes No Yes No

11 International Roaming Yes No Yes No Yes No Yes No

(not covered by SME Digitalisation Grant)

12 Credit Limit
(To Maintain Current Credit Limit) Yes No Yes No Yes No Yes No

13 Secure Mobile
(Complimentary with eligible Yes No Yes No Yes No Yes No
Maxis Business Postpaid package)

14 Others
(Unlimited data for Maxis Business Postpaid lines)

15 For Port-in

DONOR (Existing Operator)

DONOR Account No.

Company’s BRN/DONOR NRIC

16 Payment (RM)

Registration/Rate Plan Advance Payment

Registration Deposit

Device Advance Payment

Device Top Up

Others

February 2021 Page 2 of 9

SME Digitalisation Grant 2020
Registration Form

Line 5 Line 6 Line 7 Line 8

1 User’s Name

2 Mobile Number

3 Type of Service*
(New/pre-to-post/port-in/renewal/conversion)

4 Type of Line (For FlexiShare only) Individual Company Individual Company Individual Company Individual Company
or or or or
line line line line line line line line

5 Rate Plan

6 Zerolution Monthly Fee

7 Data Package/Additional Data

8 Contract Term (Months) Voice Data Voice Data Voice Data Voice Data

9 Device Model

10 Itemised Billing Yes No Yes No Yes No Yes No

11 International Roaming Yes No Yes No Yes No Yes No

(not covered by SME Digitalisation Grant)

12 Credit Limit
(To Maintain Current Credit Limit) Yes No Yes No Yes No Yes No

13 Secure Mobile
(Complimentary with eligible Yes No Yes No Yes No Yes No
Maxis Business Postpaid package)

14 Others
(Unlimited data for Maxis Business Postpaid lines)

15 For Port-in

DONOR (Existing Operator)

DONOR Account No.

Company’s BRN/DONOR NRIC

16 Payment (RM)

Registration/Rate Plan Advance Payment

Registration Deposit

Device Advance Payment

Device Top Up

Others

Note: All plans come with a contract period

* I agree to terminate existing contract for the respective line(s) registered above (if any) and be liable for the early contract termination charges which is applicable.
I agree that the Excel document attached for more than five (5) lines (if any) is true and correct.

February 2021 Page 3 of 9

SME Digitalisation Grant 2020
Registration Form
H. Add-on Solutions (not covered by SME Digitalisation Grant); *Required fields

Line 1 Line 2 Line 3 Line 4

Mobile Number

Asia Top 16 IDD Asia Top 16 IDD Asia Top 16 IDD Asia Top 16 IDD
Idd Bundle
Biz Top 25 IDD Biz Top 25 IDD Biz Top 25 IDD Biz Top 25 IDD
RM30/month each (Select One Only)
Biz Countries IDD Biz Countries IDD Biz Countries IDD Biz Countries IDD

RM6/month for RM6/month for RM6/month for RM6/month for

Device RRP of RM0 - RM500 Device RRP of RM0 - RM500 Device RRP of RM0 - RM500 Device RRP of RM0 - RM500
RM12/month for RM12/month for RM12/month for RM12/month for
Device RRP of RM501 - RM1K Device RRP of RM501 - RM1K Device RRP of RM501 - RM1K Device RRP of RM501 - RM1K
SafeDevice RM24/month for RM24/month for RM24/month for RM24/month for
(Select One Only) Device RRP of RM1,001 - RM2K Device RRP of RM1,001 - RM2K Device RRP of RM1,001 - RM2K Device RRP of RM1,001 - RM2K
RM33/month for RM33/month for RM33/month for RM33/month for
Device RRP of RM2,001 - RM4.8K Device RRP of RM2,001 - RM4.8K Device RRP of RM2,001 - RM4.8K Device RRP of RM2,001 - RM4.8K
RM43/month for RM43/month for RM43/month for RM43/month for
Device RRP of RM4,801 - RM6K Device RRP of RM4,801 - RM6K Device RRP of RM4,801 - RM6K Device RRP of RM4,801 - RM6K
Others
(Please indicate service & monthly fee)

Total Payment Per Month RM RM RM RM

Line 5 Line 6 Line 7 Line 8

Mobile Number

Asia Top 16 IDD Asia Top 16 IDD Asia Top 16 IDD Asia Top 16 IDD
Idd Bundle
Biz Top 25 IDD Biz Top 25 IDD Biz Top 25 IDD Biz Top 25 IDD
RM30/month each (Select One Only)
Biz Countries IDD Biz Countries IDD Biz Countries IDD Biz Countries IDD

RM6/month for RM6/month for RM6/month for RM6/month for

Device RRP of RM0 - RM500 Device RRP of RM0 - RM500 Device RRP of RM0 - RM500 Device RRP of RM0 - RM500
RM12/month for RM12/month for RM12/month for RM12/month for
Device RRP of RM501 - RM1K Device RRP of RM501 - RM1K Device RRP of RM501 - RM1K Device RRP of RM501 - RM1K
SafeDevice RM24/month for RM24/month for RM24/month for RM24/month for
(Select One Only) Device RRP of RM1,001 - RM2K Device RRP of RM1,001 - RM2K Device RRP of RM1,001 - RM2K Device RRP of RM1,001 - RM2K
RM33/month for RM33/month for RM33/month for RM33/month for
Device RRP of RM2,001 - RM4.8K Device RRP of RM2,001 - RM4.8K Device RRP of RM2,001 - RM4.8K Device RRP of RM2,001 - RM4.8K
RM43/month for RM43/month for RM43/month for RM43/month for
Device RRP of RM4,801 - RM6K Device RRP of RM4,801 - RM6K Device RRP of RM4,801 - RM6K Device RRP of RM4,801 - RM6K
Others
(Please indicate service & monthly fee)

Total Payment Per Month RM RM RM RM

I. Add-on Solutions *Required fields

Fibre 30Mbps Fibre 100Mbps Fibre 300Mbps Package Fibre 500Mbps Package Fibre 800Mbps Package

30Mbps RM99/month 100Mbps + 1 Unlimited 300Mbps + 1 Unlimited Calls 500Mbps + 1 Unlimited Calls 800Mbps + 1 Unlimited Calls
Calls RM139/month RM199/month RM269/month RM349/month
Business Fibre & Add-on 1 Unlimited Calls 300Mbps + 5 Voice Connect 500Mbps + 5 Voice Connect 800Mbps + 5 Voice Connect
Dynamic IP RM109 or
Voice Connect RM309 RM379 RM459
or (1000 Shareable Off net mins) (1000 Shareable Off net mins) (1000 Shareable Off net mins)
Add-on (no. of lines: )* Add-on (no. of lines: )* 300Mbps + 9 Voice Connect 500Mbps + 9 Voice Connect 800Mbps + 9 Voice Connect
RM25/line/month RM25/line/month RM399 RM469 RM549
(1800 Shareable Off net mins) (1800 Shareable Off net mins) (1800 Shareable Off net mins)

Installation Address
Unit/Floor/Block: Building Name:
Street Name: Town/City:

State: Postcode: Service Request Date (DD/MM/YY): AM PM All Day

Site Contact Name #1: Site Contact Name #2:

Contact Telephone No.: - Contact Telephone No.: -

Contact Fax No.: - Contact Fax No.: -

E-mail: E-mail:
Business Fibre &
Voice Connect Please attach list if number of row is insufficient. The username is by default the phone number. It may vary depending on Maxis Internal instructions.
To change your username details, please submit the Letter of Request (LOR) with the amendments.
Softphone Bundle
Note:
• 100/300/500/800 Mbps by default comes with unlimited calls for 1 single line/1 number with no features, only incoming and outgoing calls.
• The maximum quantity of Voice Connect lines supported is up to 60 lines per Maxis Business Fibre.
• Unlimited calls for the single line is to be surrendered if you subscribe for additional lines, this applies to 30/100/500/800 Mbps with Hosted Voice Solution (5 or 9 BVC lines).
• The existing “unlimited calls” line has no features (e.g. Pilot Hunting features are not allowed).
• You are not allowed to downgrade or reduce the quantity of Voice Connect lines offered in the above packages. E.g. if you subscribe to Maxis Business Fibre 500 Mbps that comes with 5 lines, you are not allowed to
terminate 2 out of the 5 lines. Any termination would be terminating all 5 lines.
• If you are already subscribed to Maxis Business Fibre 30 Mbps or 100 Mbps, to upgrade to Maxis Business Fibre 300/500/800 Mbps, you must subscribe to a new plan for twenty four (24) months.
• You may connect a credit card terminal to the ATA. The credit card terminal has to be connected to an individual line and port without sharing. You are not allowed to use a splitter to share the credit card terminal with the
DECT or analogue phone.
• You may subscribe for more Maxis Business Voice Connect lines on Business Fibre Internet. However, the unlimited talk time on the single line in the Business fibre Internet will cease and free on-net and shareable minutes
for off-net calls will be offered on any lines subscribed. Shareable minutes for off-net calls will be offered on any lines subscribed (excluding video calls, calls to special numbers, and calls to 1300/1800/1600/121 numbers &
IDD calls).
• The Wireless Backup Internet is meant to provide normal Internet browsing experience and usage of a minimum of one (1) Maxis Business Voice line in which the quality of the line is provided on a best-effort basis without
any service level assurance.
• All Maxis Business Voice Connect lines in the Business Fibre Internet must be within the same premise.
• Any internal & external (vertical and horizontal) cabling will be borne by you.
Note: • You must subscribe toMaxis Business Voice Connect lines to be eligible to subscribe for Voice Connect app. Each Maxis Business Voice Connect line is allowed to subscribe to one (1) Voice Connect app.
All plans come with • In order to register, login and use the Voice Connect app, you must be a Maxis postpaid mobile subscriber. Failing which you will not be able to make outgoing calls or receive incoming calls using the Voice Connect app.
24-month contract. • Please refer to Maxis Business Voice Connect and Voice Connect app respective Specific Terms and Conditions for details.

February 2021 Page 4 of 9

SME Digitalisation Grant 2020
Registration Form
Voice Connect Softphone Bundle (RM20/mth) Number of lines:

No Business Voice Numbers Package Name (first name, last name) Mobile Email COS Domain Name

Voice Connect
Business Fibre &
Voice Connect RM10/month with 30Mbps
plan
Softphone Bundle
Free with 100Mbps plan

Free with 300Mbps plan

Free with 500Mbps plan

Note:
All plans come with Free with 800Mbps plan
24-month contract.

Are you a Maxis Business Postpaid Customer: Yes No

Please select package: Enhanced mDrive Wired Solution RM69 fee/month per device + RM15 Installation fee/month per device Quantity of devices: units
Mobile Customer Price RM59 fee/month per device + RM15 Installation fee/month per device Quantity of devices: units

mDrive Plug & Play RM69 fee/month per device Quantity of devices: units
Mobile Customer Price RM59 fee/month per device Quantity of devices: units
mDrive
Person-in-charge for mDrive:
Name: Mobile Contact No.: Email:

User Details (For more than 4 users, kindly attach a separate sheet with user details as per the above table format.)
User Email Vehicle Make Vehicle Model Vehicle Colour Year Manufactured Vehicle Plate Number
e.g. [email protected] e.g. Honda e.g. City e.g. Crystal Black Pearl e.g. 2015 e.g. WDQ 8888

For Enhanced mDrive Wired Solution: Installation Date (DD/MM/YYYY): / / Installation Time (hh/mm): : am/pm

Note: Installation Address:

All mDrive plans come
with 24-month contract. Postcode*: City*: State*:

Please select package:

mWorkforce only
Quantity of licenses Quantity: licenses

Subscription tier Lite @ RM

(please select one only)
Standard @ RM
mWorkforce
Business @ RM
Device model (for Bundle plan only) N/A

Note:
24-month contract applies Person-in-charge for mWorkforce:
to all plans/services. Name: Mobile Contact No.: Email:

ONE Biz Lite package (RM18/month) eSMS Medium Plus (RM200/mth) Lite Plus (RM28/mth)

Person-in-charge for eSMS:

eSMS
Name: Mobile Contact No.: Email:

Corporate Name: Admin ID: Email ID:

Please select package Business Voice Go Lite 5 Lines - RM10/mth Business Voice Go 5 lines RM30/mth
(Only for new Maxis mobile subscribers with 24-month contract)

Voice Go Select your number preference: 1-700 0X Preferred Numbers: QTY:

Person-in-charge for Business Voice Go:

Note:
24-month contract applies. Name: Mobile Contact No.: Email:

License options: Microsoft 365 Business Basic Microsoft 365 Apps for Business Microsoft 365 Business Standard No of user(s):
(RM15/license/mth) (RM34/license/mth) (RM42/license/mth)

I have existing Microsoft domain: .ommicrosoft.com

I want to create new Microsoft domain: State your preferred domain name for your company (If not using your current domain).
The maximum number of characters you can have for your domain is up to 18 alphanumeric characters.
In the event that all 3 domain names are not available, Maxis will notify you via email.

1st Preference .ommicrosoft.com

2 Preference
nd
.ommicrosoft.com
Microsoft 365 3rd Preference .ommicrosoft.com

I want to purchase new domain: Please select domain (not covered by SME Digitalisation Grant) : .com .com.my .my
RM2/mth RM5/mth RM7/mth
Preferred Domain Name: .com/ .com.my/ .my

I want to use my current domain: .com/ .com.my/ .my

Note: I want to use my current domain .com/ .com.my/ .my

12-month contract applies. but transfer to Maxis:

February 2021 Page 5 of 9

SME Digitalisation Grant 2020
Registration Form
Teams Calling Package
Enterprise Education
Quantity of Package required: Quantity of Package required: CLIP on Pilot
Background Info: Existing O365 E5 (Maxis) Background Info: Existing O365 A5 (Maxis)
Existing O365 E5 (Non Maxis) Existing O365 A5 (Non-Maxis)
Pilot Number:
Teams Phone System Package
Enterprise Education
Quantity of Package required: Quantity of Package required:
Background Info: Existing O365 E1/E3 (Maxis) Background Info: Existing O365 A1/A3 (Maxis) Number Range:

Existing O365 E1/E3 (Non-Maxis) Existing O365 A1/A3 (Non-Maxis)

Teams Collaboration Package

Enable IDD calls
Enterprise
Quantity of Package required:

Managed UC Office 365 Partnership Contract Duration:

(Microsoft Teams) Enterprise Education
12 months
Office 365 E1. 1 license required. Office 365 A1. 1 license required.
Note: Additional E1 or A1 license for federation is required if existing O365 tenant is Non-Maxis. 24 months
Domain
36 months
Please select: .com + RM5/mth .com.my + RM7/mth .my + RM10/mth

• If have existing company domain name, please specify:

• Customer’s own Domain Name Server (if any):

• Customer’s Microsoft Office 365 Admin Contact person name:

• Customer’s Microsoft Office 365 Admin PIC Email address:

• Customer’s Microsoft Office 365 Admin Contact person telephone number:

Customers who has existing Microsoft Office 365 E1, E3, E5, A1, A3 or A5 license that was purchased from Microsoft directly or other vendor previously, Customer must to:
• Click and accept the reseller relationship link from Maxis.
• Purchase 1 additional Microsoft Office E1 license to federate their existing tenant with Maxis.
Note:
• By default CLIP on extension will be provisioned. If you required CLIP on Pilot feature, please tick ‘CLIP on Pilot’ and fill up the Pilot number in above section.
• By default IDD calls will be disabled. If you required this feature, please tick ‘Enable IDD calls’ in the above section. If you require only specific users to have IDD calls please specify the users & DID number.

Packages
Contract Period*: 12 months 18 months 24 months N/A Others: months
Digital Marketing Lite Webstore Webstore Build : (RM ) No. of Installments: for RM per month (bill based on job progress)
Build Lite Lite Upfront
Base Add-On
Contract Period*: 6 months 12 months 18 months 24 months N/A Months:
Hosting RM yearly fee RM monthly fee Details:
Domain RM yearly fee Domain name:
Email Marketing (Additional subscribers) RM monthly fee No. of subscribers:
Software Charges RM monthly fee Details:
SEO RM monthly fee No. of keywords:
Booking Engine RM yearly mthly fee No. of rooms:
eCommerce Maintenance Hours RM monthly fee Number of hours:
Workplace Productivity RM yearly mthly fee Detail:

Digital Marketing VAS

Image Design RM one-time fee. No. of images: Blog Copywriting RM one-time fee. No. of blogs:

Product Description Copywriting RM one-time fee. Number of SKUs: Photography RM one-time fee.
On-Site Consultation RM one-time fee. Detail:

Web Development VAS

SSL Certificate RM yearly fee and RM setup fee Add-on Developments Hours RM one-time fee. Number of hours:
Kentico License RM one-time fee. License: Live Chat RM monthly fee. Details:

Insights & Analytics VAS

Dashboard Setup RM one-time fee. Detail: Dashboard Subscription RM monthly fee. Detail:

Digital Marketing Starter Kit 2

• Monthly subscription • 300 digital vouchers

• 1-year contract • 300 eSMS
• Access to Digital Marketing Starter Kit platform inclusive of Education Hub
(RM255/mth) • Access to 3 workshops

Remarks:

Digital Marketing Starter Kit 3

• Upfront payment • 300 digital vouchers

• 1-year subscription • 300 eSMS
Digital Marketing • Access to Digital Marketing Starter Kit platform inclusive of Education Hub
(RM2,880/year) • Access to 3 workshops

Remarks:

Digital Marketing Starter Kit 4

• Upfront payment • 2,300 digital vouchers

• 1-year subscription • 30,300 eSMS
• Access to Digital Marketing Starter Kit platform inclusive of Education Hub
(RM9,880/year) • Access to 3 workshops

Remarks:

February 2021 Page 6 of 9

SME Digitalisation Grant 2020
Registration Form
Cloud POS Plans

Cloud POS Basic Plan (RM198/mth) Quantity: plan(s) Cloud POS Pro Plan (RM288/mth) Quantity: plan(s)
Ideal for Retail Ideal for F&B
• 1 store location • Unlimited SKUs • 1 store location • Unlimited SKUs
• 2 POS access • Unlimited user licenses • 2 POS access • Unlimited user licenses

Additional Cloud POS License(s)

Mobile App Access (RM120/mth) Quantity of license(s):

Kitchen Display System (RM100/mth) Quantity of license(s):

Additional Hardware & Software

STAR mPOP (Cash Drawer, Receipt Printer & Tablet Stand) (RM2000 upfront payment per unit) Quantity: unit(s)

Other Hardware: Total RM:

Other Software: Total RM:

Onsite Support
Cloud POS
Onsite Setup Preferred Date:

Onsite Training Preferred Date:

Project Management Preferred Date: Total RM:

Cloud POS Lite Plans Note: Bundle plans come with 1 Android POS terminal and unlimited transactions with POS Lite Solution

Cloud POS Lite Cloud POS Lite Cloud POS Lite F&B Upfronta Cloud POS Lite F&B Upfront Bundle
F&B (RM100/mth) F&B Bundle (RM200/mth) (RM2,000 one-time) (RM3,860 one-time)

• Caters in-store, takeaway • Caters in-store, takeaway • Solution Lifetime Access • Solution Lifetime Access
and online orders and online orders • Caters in-store, takeaway • Caters in-store, takeaway
• Integrated to online • Integrated to online and online orders and online orders
payment and delivery payment and delivery • Integrated to online • Integrated to online
providers providers payment and delivery payment and delivery
• 24-month period • Includes Android POS providers providers
terminal with attached • Includes Android POS
Quantity: plan(s) Quantity: plan(s)
receipt printer terminal with attached
Remarks: • 24-month period Remarks: receipt printer
• Bundle in for first 12 months;
Quantity: plan(s)
rolling RM30 monthly
Remarks: charge 13th month onwards
Optional: Optional:
Cloud POS Rate Plan Cloud POS Rate Plan Quantity: plan(s)
(unlimited data with POS (unlimited data with POS
Lite Solution) (RM30/mth) Lite Solution) (RM30/mth) Remarks:

Onsite Support
Note: Onsite Traning: Within KV, JB, PG Island Within Peninsular Within East Malaysia
24-month contract applies
to all plans/services. Preferred Date: Total RM:

Line 1 Line 2 Line 3 Line 4

mPOS with Maxis Business/ mPOS with Maxis Business/ mPOS with Maxis Business/ mPOS with Maxis Business/
FlexiShare plan FlexiShare plan FlexiShare plan FlexiShare plan
mPOS (RM22/mth per plan) (RM22/mth per plan) (RM22/mth per plan) (RM22/mth per plan)

Rate Plan Others: Others: Others: Others:

(Select One Only)

Line 5 Line 6 Line 7 Line 8

Note:
All mPOS plans come mPOS with Maxis Business/ mPOS with Maxis Business/ mPOS with Maxis Business/ mPOS with Maxis Business/
with 24-month contract. FlexiShare plan FlexiShare plan FlexiShare plan FlexiShare plan
Each Basic mPOS plan (RM22/mth per plan) (RM22/mth per plan) (RM22/mth per plan) (RM22/mth per plan)
comes with one unit card
reader and limitless
mPOS transactions. Others: Others: Others: Others:

J. Summary of Service Package(s)

Solutions subscribed:

Total commitment amount (RM):

Total contract period:

SME Digitalisation Grant Claim Amount: 30% or 50%

Total claimable under SME MDEC Grant:

February 2021 Page 7 of 9

SME Digitalisation Grant 2020
Registration Form
K. Declaration

By signing below, I/We hereby declare: (I) that I/We wish to subscribe for the Service(s) provided by Maxis Broadband Sdn. Bhd. (MBSB). (II) that the above information provided is true and correct. (III) that I/We
have been provided with and have read and understood the Summary; and Agreement in its entirety and agree to the terms and conditions of the Summary and Agreement provided, printed and/or attached
hereto. (IV) (In respect of corporate / business / non-individual customers): that I/We consent to the collection and processing of my / our employees, representative and / or signatories Personal Data in
accordance with the Maxis Group Privacy Statement (available on our website at www.maxis.com.my/pdpa) and agree that the Maxis Group Privacy Statement shall form an integral part of the Agreement. (V) (In
respect of corporate/business / non-individual customers): that I/We consent to MBSB contacting me / our employees, representative and/ or signatories within 6 months of my / our employees, representative
and / or signatories leaving / terminating my / our employees, representative and / or signatories Service(s) with MBSB. I/We understand that it is for the purpose of getting my / our employees, representative
and / or signatories feedback and to improve the products and Service(s) of MBSB. MBSB will continue to maintain the privacy of my / my employees, representative and / or signatories data during this time.

Company’s Stamp

Authorised Signatory’s Signature

Name:

NRIC/Passport No.:

Designation: Date (DD/MM/YY):

L. Device Redemption On-the-spot Details

Approved By (Maxis/dealer) Device Issue By: Acknowledged Receipt:

Registration Verified and Approved by: Kindly attach itemised DO:

Name: Name: Name:

NRIC No.: - - NRIC No.: - - NRIC No.: - -

Date (DD/MM/YY): Date (DD/MM/YY): Date (DD/MM/YY):

Remarks: Remarks: Remarks:

M. For Office Use Only

Master Account ID: Collection Code: Dealer Company Stamp

Parent Account ID: Account Manager:

Parent Company Name: Dealer/Retail Source Code:

Account No.: Promotion/Offer:

Account Category: Case No.:

Market Code: Date of Activation (DD/MM/YY):

February 2021 Page 8 of 9

Summary Terms and Conditions of Maxis Service(s) (“Summary”)
Your Agreement with Maxis comprises the General Terms and Conditions (“General Terms”), Service Specific Terms &
Conditions applicable to you, the Maxis Group Privacy Statement and the Maxis Fair Usage Policy (“Agreement”). These
are all located on our official website at www.maxis.com.my/tnc/business and www.maxis.com.my/pdpa. Alternatively
please visit your nearest Maxis Centre for hard copies.

This Summary highlights some of the important terms of the Agreement. When you purchase the Maxis Service(s), the
Agreement in its entirety (and not just this Summary) applies to you. Please read and understand the contents of the
Agreement in its entirety. Terms used in this Summary will have the same meaning as defined in the General Terms. In
the event of any inconsistency or conflict between the Summary and the General Terms, the General Terms will prevail.

Your Personal Information

We will process your Personal Information pursuant to the Personal Data Protection Act 2010 and the Maxis Group
Privacy Statement. These explain your rights to and our usage of your Personal Information. Our Maxis Group Privacy
Statement is found at all our Maxis Centres and our website at www.maxis.com.my/pdpa. Call us at 1800 82 1123 or
74922123 or e-mail us at [email protected] if you need a copy.

Your Obligations When You Use The Service(s):

You must:
• comply with the Agreement in its entirety; comply with all applicable laws of Malaysia and instructions issued by us;
• promptly pay Charges in full without deduction and protect Our Equipment;
• not disclose your Log-On Details to others;
• not use the Service(s):
(a) to send spam, unsolicited messages (including SMS’ and emails), and messages against public interest;
(b) for re-sale unless permitted by Maxis;
(c) for fraudulent, unlawful and improper purpose such as gambling, vice, infringement of intellectual property rights,
publishing any defamatory or abusive material; and
(d) for any activity which is likely to cause Network congestion.

The Service(s) We Supply, Our Liability and What You Can Expect of Us:
Our Service(s) may not be available everywhere. Please check Our Network coverage area on our official website at
maxis.com.my/network. Whilst we will make every attempt to provide a fault free service, the Service(s) are not fault free
from Matters Beyond Our Control. We are not liable to you or any other party, in contract, tort (including negligence), or
otherwise for any loss or damage that you may suffer in connection with the Service(s).

Change of Service Plan

Request for a change of Service plan is based on our approval and at your cost.

Good and Services Tax (“GST”) Provisions

We will provide you with a tax invoice if GST is applicable.

When We Can Suspend or Terminate Your Service(s):

We may suspend or terminate your Service(s) in a number of circumstances, including where you breach Our
Agreement, late payment or failure to make payment , Network related issues (including emergencies), or use the
Service(s) for improper purposes or for damaging our Network or when you resign or leave your Company or
insolvency. If the Service(s) is/are suspended or terminated, you must still pay all outstanding Charges and charges for
Service(s) reconnection.

What We Can Do In Relation To The Service(s):

We may from time to time make any changes, including revising the Charges. Changes will be notified via Maxis’
official website.

Complaints
We appreciate any feedback about our Service(s), and are committed to resolving problems or complaints quickly. If you
have any concerns, please contact us at 1-800-82-1919 or dial 1919 from your mobile.

You acknowledge that you have been provided with and have read and understood the Agreement in its entirety, and
you agree to the terms and conditions of the Agreement.
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