Stop Indosat M2

FORMULIR PERMOHONAN PENGHENTIAN BERLANGGANAN TERMINATION SUBSCRIPTION FORM SF No.

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Tanggal Date :

IM2 INDOSATNet CONSUMER



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INFORMASI PELANGGAN CUSTOMER INFORMATION INFORMASI PELANGGAN CUSTOMER DATA

INFORMASI LAYANAN SERVICE INFORMATION

Nama Pelanggan Customer Name

Jenis Layanan Type of Service

Alamat Pelanggan Customer Address

Customer ID Masa Kontrak Contract Periode Mulai dari Start Subscribing from

Kota City

Propinsi Province

Negara Country

Kode Pos Zip Code

sampai dengan until HASIL KONFIRMASI CONFIRMATION RESULT

Telepon Rumah

Account Executive INDOSATM2

Telephone

Contact Person Pelanggan

Seluler Celular

Customer Contact Person

Faksimili Facsimile

Tanggal Konfirmasi Confirmation Date

Email

Tanggal Pemutusan Berlangganan Abonement Termination Date

ALASAN PENGHENTIAN BERLANGGANAN CONTRACT DISMANTLE REASON Pindah ke ISP lain, dengan alasan Move to other ISP with reasons:

Non Teknis: Non Technical Problem:

Teknis Technical Problem:



Tagihan sering tidak akurat Inaccurate billing statement



Late billing statement



complains weren’t well responded



Akses Lambat Slow Access



Koneksi sering putus Unstable connection



Akses putus, lama diperbaiki Slow repairment process



Email bermasalah Email Problem

Billing sering terlambat/tidak datang Komplain tidak direspon dengan baik

Khusus pelanggan IM2 Broadband 3.5 G



Especially for IM2 3.5G Broadband Customers



Pindah alamat/pindah lokasi



Change address/change location





Sinyal lemah Bad Signal



Modem Rusak Modem out of Service



Gagal Koneksi Connection Failure



Uncovered Area (Name the area)

Area tidak tercover (sebutkan area

)

Non Teknis: Non Technical Problem:



Petugas tidak sopan dalam melayani Officers show impolite manner

Efisiensi pengeluaran Cost efficiency

Pindah ke produk Indosat IM2 lain Move to other services from IM2



Nama Produk Product Name



Alasan Reason

Harga provider lain lebih menarik







Petugas IM2 jarang mengunjungi IM2 officers rarely visit

Other Provider Offers Cheaper Price

Fitur/Paket Layanan provider lain lebih sesuai kebutuhan

Keterangan (mohon dijelaskan dengan singkat alasannya) Additional Descriptiom (please specity the reason)

Other provider offers service package with more suitable features

Catatan: Mohon dilampirkan fotokopi kartu identitas (KTP/SIM/Paspor)

Pelanggan Customer

Note: Please attach Copy of ID/Driving License/Passport

Nama dan Tanda Tangan Name and Signature

Penerima Reciever

Hari/Tanggal Day/Date

Catatan Notes • Putih White : Administrasi Penjualan Sales Administration • Biru Blue : Pelanggan Customer • Merah Red : Provisioning • Hijau Green : NOC • Kuning Yellow : Account Executive

FL0307

DITERIMA OLEH SALES ADMINISTRASI RECEIVED BY CUSTOMER ADMINISTRATION