EM/T&IT/001

T&IT-ADSL - 17/11/005
Thanlyin Star City Project
Estate Management
Telecoms & IT (Operation ) Department
ADSL Application Form
Date : 1-11-2017
(1) Customer Information

Customer Name Mr.Ellie NRC/Passport No

Building No. B3 Apartment No 304

Email Address Contact Phone No

(2) ADSL Services Requested

Class of Speed 512Kbps 4 1Mbps 2Mbps 5 Mbps EM 4

Subscription Period 12 Months 6 Months 4 3 Months 1 Month OMP

New Installation Extened 4 New Modem Purchase

(3) Billing Information

No Description From To

1 Extend 1-Nov-17 31-Jan-18

Period (Per
Description Price (Per Month) Amount (MMK)
Month)
Activation Fee 100,000 -

1 Mbps Modem Fee 50,000 3 -

Data Usage Fee 65,000 195,000

New Moderm 50,000 -

Discount on Data Usage 5,000
Account Name - Utility Operation Sub Total 190,000
Account No - 000110288500386 5% commercial Tax 9,500
BankNameYomaBank TOTAL 199,500

Applicant Name Mr.Ellie Signature

" Notice - ADSL Internet Line will be setup within 2 days after cash receive."