Refund Request Form

Customer Details Individual   Corporate/Enterprise Name :* NRIC/ Passport :      * Company Name :* BRN : * Authorised Person : * NRIC/Passport :        * redONE Mobile No: * other Contact No.: * redONE Acc. No. : Email Address :  Refund Details Bank Name: * --Please Select-- AFFIN BANK AGROBANK AL-RAJHI BANK ALLIANCE BANK AMBANK BANK ISLAM MALAYSIA BANK KERJASAMA RAKYAT MALAYSIA BANK MUAMALAT BANK OF AMERICA (MALAYSIA) BERHAD BANK OF CHINA BANK OF TOKYO BANK SIMPANAN NASIONAL BNP PARIBAS CIMB BANK CITIBANK DEUTSCHE BANK (M) BERHAD HONG LEONG BANK HSBC BANK J.P.MORGAN KUWAIT FINANCE HOUSE MAYBANK MIZUHO BANK OCBC BANK PUBLIC BANK RHB BANK ROYAL BANK OF SCOTLAND BERHAD STANDARD CHARTERED BANK SUMITOMO MITSUI BANK UNITED OVERSEAS BANK Account Holder Name: * Account No: * Current Account Savings Account Reason for Refund :* Application Terminated / Cancelled Activation Issue Sim Delivery Issue Others Other Reason :# # If reason due to over payment, payment proof required   Customer Declaration By signing this Refund Request, I/we hereby acknowledge, declare, and confirm that: All statement and information given in this Refund Request are true and accurate. I/we have read and fully understood all the terms and conditions stated in this Refund Request before signing below. I/we understand and agree that Red One Network Sdn Bhd (“redONE”) shall refund the deposit (if applicable) after redONE has deducted any outstanding payment payable to redONE. I/we understand that the outstanding payment mentioned is inclusive of ALL the outstanding payment by ALL the account registered under the my/our name. redONE will process my personal data under a legal obligation and redONE will keep my personal data confidential and will share it only with the competent authorities where required by law. Authorised Signatory Signature  Date :   Required Supporting Document Type of Supporting Document : --Please Select-- Individual Sole Proprietorship/Enterprise/Partnership/Society/Government Body/Agencies/LegalFirm Company Deceased Registered Owner NRIC NRIC FRONT NRIC BACK Letter of Authorization SNAP NRIC Copy of Authorized Person NRIC FRONT NRIC BACK NRIC Copy of Authorized Person (Representative) NRIC FRONT NRIC BACK SSM SNAP LOA with Official Letterhead SNAP NRIC Copy of Authorized Person (3rd Party)** NRIC FRONT NRIC BACK NRIC Copy of Authorized Person (Representative) NRIC FRONT NRIC BACK Form 9/Form 13(if necessary) / Section 14/Section 7 SNAP Death certificate of the deceased SNAP NRIC Copy of next-of-kin NRIC FRONT NRIC BACK Others SNAP APPLICATION UNDER NAME OF: SUPPORTING DOCUMENT: Individual 1. Signed Refund Form 2. NRIC / Passport Copy 3. Letter of Authorization** 4. NRIC Copy of Authorized Person (3rd Party)** Sole Proprietorship / Enterprise / Partnership / Society / Government Body / Agencies / Legal Firm 1. Signed Refund Form 2. NRIC Copy of Authorized Person (Representative) 3. SSM 4. Letter of Authorization with Official Letterhead** 5. NRIC Copy of Authorized Person (3rd Party)** Company 1. Signed Refund Form 2. NRIC Copy of Authorized Person (Representative) 3. Form 9/Form 13(if necessary) / Section 14/Section 7 Deceased Registered Owner* 1. Refund Form signed by next-of-kin 2. Death certificate of the deceased 3. NRIC Copy of next-of-kin ** Refund Details (3rd Party) NOT SAME with APPLICATION NAME