Sales code

FORMULIR PENDAFTARAN LAYANAN CBN JENIS PENDAFTARAN

CBN service application form Subscription Status Baru - New Daftar Ulang - Reactivation
www.cbn.id CBNinternet

DATA PELANGGAN / CUSTOMER DATA

NAMA PELANGGAN
Full Name

TEMPAT/TANGGAL LAHIR
Place/Date of birth dd/mm/yyyy / /
NOMOR IDENTITAS JENIS KELAMIN
Pria - Male Wanita - Female
ID Card No. Gender

TELEPON RUMAH TELEPON SELULAR

Home Phone Mobile Phone

Data yang tercantum harus sesuai dengan identitas pelanggan yang berlaku. Semua pelanggan baru CBN diwajibkan untuk menyertakan kopi identitas yang berlaku.
The data declared above must be valid. All CBN subscribers are required to attach a copy of valid ID Card.

ALAMAT PEMASANGAN / INSTALLATION ADDRESS

ALAMAT PEMASANGAN
Installation Address

KODE POS
RT RW
Zip Code

ALAMAT EMAIL
Email Address

Alamat pemasangan di atas akan berlaku sebagai alamat penagihan biaya berlangganan Anda. Jika alamat penagihan berbeda dengan alamat pemasangan, maka tagihan akan dikirimkan via e-billing ke alamat email yang tercantum di atas.
Your installation address will also act as your billing address. If the billing address is different, then the invoice will be sent via e-billing to the email listed above.

PILIHAN PAKET LAYANAN / SERVICE PACKAGE OPTIONS PILIHAN LAYANAN TAMBAHAN / ADDITIONAL SERVICE OPTIONS

FIBER BROADBAND DIRECTNET PLAY (WIRELESS) LAYANAN TAMBAHAN - ADDITIONAL SERVICES ADD ONS CHANNELS

Fiber Broadband 15 DirectNet Bronze CBN Mail ............ Factual Time

Fiber Broadband 30 DirectNet Silver DNS Services ............ Trend Time

Fiber Broadband 50 DirectNet Gold ................................... Winning Time

Fiber Broadband 100 ................................. PERANGKAT TAMBAHAN - ADDITIONAL DEVICES Popcorn Time
Fiber Broadband 1G .................................
Wireless Router ............
.................................
Dens.TV Smart Box ............
Pelanggan akan mendapatkan satu akun email (5GB) untuk setiap pendaftaran layanan CBN. Penambahan layanan dan perangkat lainnya akan
dikenakan biaya tambahan. Harga paket CBN Fiber Broadband sudah termasuk family premium channels.
Harga belum termasuk rental Family smartbox dan ONU.
............................................
Untuk keterangan lebih lanjut silahkan mengunjungi https://www.cbn.net.id/personal/support/terms-of-service.html
Customer will get one email account (5GB) for every CBN Service subscription. Additional services and devices will be charged. CBN Fiber Broadband Layanan Add Ons TV dan Family smartbox hanya berlaku untuk layanan CBN Fiber Broadband.
package price includes family premium channels. Price not included Family smartbox and ONU rental fee. Add Ons TV and Family smartbox services are only available for CBN Fiber Broadband.
For more information, visit https://www.cbn.net.id/personal/support/terms-of-service.html

METODE PEMBAYARAN / PAYMENT METHOD PERINCIAN BIAYA / PAYMENT DETAILS

Bagian ini akan diisi oleh CBN - to be completed by CBN

Autodebit Credit Card ATM Internet Banking / Mobile Banking
Biaya Pemasangan - installation charges
Biaya Paket - monthly charges
Saya memberikan wewenang kepada PT. Cyberindo Aditama untuk melakukan penagihan melalui Biaya Tambahan - additional charges
Visa/Master Card untuk segala biaya CBN yang saya gunakan selama masa berlangganan.
I authorize PT. Cyberindo Aditama to debit my Visa/Master Card for all my CBN expenses during subscription period. Biaya Services - service charges
Biaya Add Ons - add ons charges
Biaya Perangkat - device charges
Apabila terjadi gagal pembayaran Autopay melalui Kartu Kredit yang didaftarkan (dikarenakan (antara lain: kartu tidak valid/tidak aktif/terblokir),
maka bank terkait berhak untuk membebankan tagihan tersebut pada Kartu Kredit Anda yang aktif berdasarkan data yang dimiliki oleh bank. Biaya Lainnya - other charges
If there is an Autopay payment failure through the applied Credit Card (due to: invalid/inactive/blocked card),
then the bank will have the authority to charged the payment to your active Credit Card based on the data from the bank. PPN 10% - VAT 10%
Untuk pembayaran melalui Autodebit Credit Card, harap untuk melampirkan copy halaman depan kartu Anda.
For Autodebit Credit Card payment, please attach a front copy of your credit card.
TOTAL
Keterangan lebih lanjut mengenai metode pembayaran lainnya silahkan mengunjungi:
www.cbn.net.id/personal/support/account-billing/payment-methods.html Total biaya di atas berlaku untuk pembayaran pertama dan harus dilunasi maksimal 10 hari setelah aktivasi.
More information on other payment methods, visit: https://www.cbn.net.id/personal/support/account-billing/payment-methods.html The total charges above is for first payment and must be paid maximum 10 days after activation.

AKTIVASI LAYANAN / SERVICE ACTIVATION JADWAL PEMASANGAN / INSTALLATION SCHEDULE

Username dan password akan digunakan untuk akun CBN mail, Dens.TV, layanan internet dan Member Center Anda. TANGGAL PEMASANGAN - INSTALLATION DATE
Username and password will be used for CBN mail, Dens.TV, internet service and your Member Center.
Username diawali dengan huruf dan diakhiri dengan huruf atau angka, minimal 3 karakter dan maksimal 16 karakter. Harus berupa huruf
kecil dan/atau simbol garis bawah (_),simbol titik(.), simbol minus (-).
Username must be started with a character and ended with character or number, minimum 3 characters and maximum 16 characters.
Hari - day dd/mm/yyyy / /
Must consists of lowercase and/or underscore (_), dot (.), dash (-).

USERNAME
WAKTU PEMASANGAN - INSTALLATION TIME
@ cbn.net.id Fiber Broadband
Password sementara harus berbeda dengan username, minimal 6 karakter dan maksimal 12 karakter. Terdiri dari kombinasi huruf kecil, huruf besar 09.00-11.00 11.00-13.00 13.00-15.00 15.00-17.00
dan angka. Pegiriman tagihan bulanan dan informasi terkait layanan CBN lainnya akan dikirimkan ke alamat email cbn.net.id milik Anda.
Temporary password must be different from username, minimum 6 characters and maximum 12 characters. Consist of combination of lowercase,
uppercase and number. Information regarding monthly billing and other CBN services will be sent to your cbn.net.id email.
DirectNet Play
PASSWORD 09.00-12.00 13.00-16.00
Jadwal pemasangan dapat berubah sewaktu-waktu sesuai dengan slot jadwal yang tersedia.
The installation schedule is subject to change depends on the schedule slot availability.

Syarat dan ketentuan : Saya dengan ini menyatakan bahwa semua keterangan yang diisi adalah benar, serta menerima dan bersedia untuk Notes ................................................................................................................................................................
terikat pada seluruh ketentuan berlangganan yang telah ditetapkan CBN seperti yang tertera pada
https://www.cbn.net.id/personal/support/terms-of-service.html ..........................................................................................................................................................................
CBN berhak menolak permohonan berlangganan ini berdasarkan dengan peraturan dan ketentuan yang berlaku di CBN.
Terms and conditions : I hereby declare that all the information above are true and consent to terms that CBN has assigned as written in ..........................................................................................................................................................................
https://www.cbn.net.id/personal/support/terms-of-service.html.
CBN has the right to reject this application based on terms and conditions that applied for CBN. ..........................................................................................................................................................................

Tanggal - date : .............................

_____________________________ _____________________________ _____________________________

Tanda tangan pelanggan - customer signature Tanda tangan sales - sales signature Tanda tangan sales SPV - sales SPV signature
CA-JKT-RSL-FRM-1701002-1.0