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This is a PLDT service application form through a PLDT accredited Agent. Processing of your application begins only upon submission of complete application details and of one valid ID.

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First Name

Middle name

Last name

Gender

Male Female

Birth Date

Primary contact number

Secondary contact number

Email Primary

Email Secondary

ADDRESS DETAILS

Unit/House number

Street name

Village/Subdivision

Barangay

City/Municipality

District/Province

Zip code

Nearest landmark

Remarks/Comments