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SMARTPAY ONLINE

www.e-smartpay.com.my

Please tick where appropriate:

V1.8

(A) SMARTPAY ONLINE REGISTRATION

I would like to register for SmartPay Online (www.e-smartpay.com.my)

Please complete this user registration form by providing all the relevant information and fax to us at 1-300-88-8383. Photocopies of this user registration form are acceptable if you want to register for more than two

(2) users. This user registration form is also available for download on the SmartPay Online website. Please note that all fields are mandatory and must be filled accurately. The Password will be sent to the users’ registered email address upon successful registration.

Company Name

Office No.

Contact Person

Fax No.

 

User 1

User 2

 

 

 

Email*

Full Name

IC No.

Designation

Mobile No.

Account No.(s)**

*Email address is used as the login ID. Email address provided must be different, unique and valid for each user.

**You can assign more than one (1) SmartPay account for each UserID.

SmartPay Online is currently provided free-of-charge to SmartPay customers only. Usage of SmartPay Online is governed by the SmartPay Online Terms of Service and Privacy & Security Policy (available upon issuance of Password via email). PETRONAS Dagangan Berhad reserves the right to modify these Terms of Service and Privacy & Security Policy from time to time without notice.

Please review these Terms of Service and Privacy & Security Policy from time to time so that you will be informed of any changes.

By completing and returning this SmartPay Online application form to PETRONAS Dagangan Berhad, I / we hereby agree to be bound by the SmartPay Online Terms of Service and Privacy & Security Policy.

PETRONAS Official Use Only

Received

Reviewed

Processed

Created

(B) FOR PREPAID ACCOUNT ONLY

I would like to continue receiving my monthly SmartPay statement(s) for Account No(s) _____________________________________________________________________ effective ________________ (dd/mm/yyyy) and I understand that there will be charge of RM5 per statement.

I would like to discontinue receiving my monthly SmartPay statement(s) for Account No(s) __________________________________________________________________ effective ________________ (dd/mm/yyyy).

Authorised Signatory

Full Name

Designation

Date

Official Company Stamp

Card Services Department, PETRONAS Dagangan Berhad, Level 25, Tower 2, PETRONAS Twin Towers, KLCC, 50088 Kuala Lumpur

Please fax this completed user registration form back to us at 1-300-88-8383. For more information, please contact us at our Mesralink hotline 1-300-88-8181 or email us at mesralink@petronas.com.my.