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Complete Personal Information
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Confirmation

Personal Information

(I already fill this form before. Continue to my latest information)

Salutation

Full Name

This must match your ID

Additional Contact Number

We will call you on this number to arrange Nice Number delivery

Email Address

We will send the monthly invoice to this Email address

Government Regulatory click here for Regulatory press released

Mother's Maiden Name

Family Card Number

ID Card Photo

Upload photo of your ID card

Or send your ID card photo to

Please Email your ID Card photo to PRIORITAS@xl.co.id and put the Application Number in the subject of the Email

Delivery Address

Province

City

Delivery is free
Delivery is free

Free and secure delivery at your door step.

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Safe and secure

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