<!DOCTYPE html>
<html>
<head>
	<style type="text/css">
		body{
			font-family: 'Helvetica','sans-serif';
		}
		.fontStyle1 {
			font-size: 8px;
			line-height: 10px;
		}
		.fontStyle1 p{
			margin-top: 0px;
			margin-bottom: 0px;
		}
		.page-break {
		    page-break-after: always;
		}
	</style>
</head>
<body>
	<!-- Address -->
	<table width="100%">
		@if($package->name != '1' && $package->contract == '24' && $created >= '2020-08-12')
			<tr>
				<td align="left" style="font-size: 10px">
					<b style="color: red">PROMOTION (RM 10 off for 24 months)</b>
				</td>
				
			</tr>
		@else	
		@endif
		<tr>
			<td align="right" class="fontStyle1">
				<b>ALLO TECHNOLOGY SDN BHD</b>
				<p>Cyberview Garden Villas, Persiaran Multimedia, Cyber 7</p>
				<p>63000 Cyberjaya, Selangor Darul Ehsan</p>
				<p>Tel: 03-8800 5222 Fax 03-8800 5221</p>
				<p>E-mail:customerservice@citybroadband.my</p>
				<p>Website:www.citybroadband.my</p>
			</td>
		</tr>
		<tr>
			<td height="10"></td>
		</tr>
		<!-- Title -->
		<tr>
			<td style="border: 1px solid #000">
				<table width="100%">
					<tr>
						<td align="center" style="font-size: 13px;line-height:16px;font-weight:bold">
							BROADBAND INTERNET ACCESS SERVICE APPLICATION FORM
						</td>
					</tr>
				</table>
			</td>
		</tr>
		<tr>
			<td height="7"></td>
		</tr>
		<tr>
			<td style="font-size: 10px;font-style: italic;">Please write in CAPITAL LETTERS and tick(/) where required</td>
		</tr>
		<tr>
			<td height="7"></td>
		</tr>
		<!-- Application Type-->
		<tr>
			<td>
				<table>
					<tr>
						<td style="font-size: 11px;">APPLICATION:</td>
						<td width="20">&nbsp;</td>
						<td style="width: 16px;border:1px solid #000">
							<span>
								@if($form->Form->type_service == "New")
								<img src="{{ url('/assets/tick.png') }}" style="width:14px; height:auto">
								@endif
							</span>
						</td>
						<td style="font-size: 10px;">New</td>
						<td width="20">&nbsp;</td>
						<td style="width: 16px;border:1px solid #000">
							<span>
								@if($form->Form->type_service == "Upgrade")
								<img src="{{ url('/assets/tick.png') }}" style="width:14px; height:auto">
								@endif
							</span>
						</td>
						<td style="font-size: 10px;">Upgrading/Downgrading</td>
						<td width="20">&nbsp;</td>
						<td style="width: 16px;border:1px solid #000">
							<span>
								@if($form->Form->type_service == "Relocation")
								<img src="{{ url('/assets/tick.png') }}" style="width:14px; height:auto">
								@endif
							</span>
						</td>
						<td style="font-size: 10px;">Relocation(RM150)</td>
						<td width="20">&nbsp;</td>
						<td style="width: 16px;border:1px solid #000">
							<span>
								@if($form->Form->type_service == "Rectification")
								<img src="{{ url('/assets/tick.png') }}" style="width:14px; height:auto">
								@endif
							</span>
						</td>
						<td style="font-size: 10px;">Rectification</td>
					</tr>
				</table>
			</td>
		</tr>
		<!-- Application Type-->
		<tr>
			<td>
				<table border="0" cellpadding="0" cellspacing="0" width="100%">
					<tr>
						<td bgcolor="#b4b4e1" style="font-size: 12px;font-weight: bold; padding: 5px 3px;">
							<span style="display:inline-block;border-bottom:1px solid black; padding-bottom:0px;margin-bottom: 0px">APPLICATION INFORMATION</span>
						</td>
					</tr>
					<tr><td height="5"></td></tr>
					<tr>
						<td>
							<table border="0" cellpadding="0" cellspacing="0" width="100%">
								<tr>
									<td width="28%" style="font-size: 11px;">Full Name</td>
									<td width="72%" height="18" style="font-size: 11px;border:1px solid black;padding:0px 3px;word-wrap: break-word;">{{ $form->name }}</td>
								</tr>
								<tr><td colspan="2" height="10"></td></tr>
								<tr>
									<td colspan="2">
										<table border="0" cellpadding="0" cellspacing="0" width="100%">
											<tr>
												<td width="28%" style="font-size: 11px;">NRIC/Passport No.</td>
												<td width="24%" height="18" style="font-size: 11px;border:1px solid black;padding:0px 3px;word-wrap: break-word;">{{ $form->ic }}</td>
												<td width="24%" style="font-size: 11px;text-align:right;padding-right: 10px">Gender</td>
												<td width="24%" height="18" style="font-size: 11px;border:1px solid black;padding:0px 3px;word-wrap: break-word;">{{ $form->gender }}</td>
											</tr>
										</table>
									</td>
								</tr>
								<tr><td colspan="2" height="10"></td></tr>
								<tr>
									<td colspan="2">
										<table border="0" cellpadding="0" cellspacing="0" width="100%">
											<tr>
												<td width="28%" style="font-size: 11px;">Primary Contact No.</td>
												<td width="24%" height="18" style="font-size: 11px;border:1px solid black;padding:0px 3px;word-wrap: break-word;">{{ $form->phone1 }}</td>
												<td width="24%" style="font-size: 11px;text-align:right;padding-right: 10px">Secondary Contact No.</td>
												<td width="24%" height="18" style="font-size: 11px;border:1px solid black;padding:0px 3px;word-wrap: break-word;">{{ $form->phone2 }}</td>
											</tr>
										</table>
									</td>
								</tr>
								<tr><td colspan="2" height="10"></td></tr>
								<tr>
									<td colspan="2">
										<table border="0" cellpadding="0" cellspacing="0" width="100%">
											<tr>
												<td width="28%" style="font-size: 11px;">Citizenship</td>
												<td width="24%" height="18" style="font-size: 11px;border:1px solid black;padding:0px 3px;word-wrap: break-word;">{{ $form->citizen }}</td>
												<td width="10%" style="font-size: 11px;text-align:right;padding-right: 10px"> E-mail</td>
												<td width="38%" height="18" style="font-size: 11px;border:1px solid black;padding:0px 3px;word-wrap: break-word;">{{ $form->email }}</td>
											</tr>
										</table>
									</td>
								</tr>
							</table>
						</td>
					</tr>
					<tr><td height="2"></td></tr>
				</table>
			</td>
		</tr>
		<!-- Installation Address -->
		<tr>
			<td>
				<table border="0" cellpadding="0" cellspacing="0" width="100%">
					<tr>
						<td bgcolor="#b4b4e1" style="font-size: 12px;font-weight: bold; padding: 5px 3px;">
							<span style="display:inline-block;border-bottom:1px solid black; padding-bottom:0px;margin-bottom: 0px">INSTALLATION ADDRESS</span>
						</td>
					</tr>
					<tr><td height="5"></td></tr>
					<tr>
						<td>
							<table border="0" cellpadding="0" cellspacing="0" width="100%">
								<tr>
									<td width="28%" style="font-size: 11px;">Unit.No </td>
									<td width="72%" height="18" style="font-size: 11px;border:1px solid black;padding:0px 3px;word-wrap: break-word;">{{ $form->unit_no }}</td>
								</tr>
								<tr><td colspan="2" height="10"></td></tr>
								<tr>
									<td width="28%" style="font-size: 11px;">Building</td>
									<td width="72%" height="18" style="font-size: 11px;border:1px solid black;padding:0px 3px;word-wrap: break-word;">{{ $form->building_name }}</td>
								</tr>
								<tr><td colspan="2" height="10"></td></tr>
								<tr>
									<td width="28%" style="font-size: 11px;">Street</td>
									<td width="72%" height="18" style="font-size: 11px;border:1px solid black;padding:0px 3px;word-wrap: break-word;">{{ $form->street }}</td>
								</tr>
								<tr><td colspan="2" height="10"></td></tr>
								<tr>
									<td colspan="2">
										<table border="0" cellpadding="0" cellspacing="0" width="100%">
											<tr>
												<td width="28%" style="font-size: 11px;">City/State</td>
												<td width="32%" height="18" style="font-size: 11px;border:1px solid black;padding:0px 3px;word-wrap: break-word;">{{ $form->city }} / {{ $form->state }}</td>
												<td width="15%" style="font-size: 11px;text-align:right;padding-right: 10px"> Postcode</td>
												<td width="25%" height="18" style="font-size: 11px;border:1px solid black;padding:0px 3px;word-wrap: break-word;">{{ $form->postcode }}</td>
											</tr>
										</table>
									</td>
								</tr>
							</table>
						</td>
					</tr>
					<tr><td height="2"></td></tr>
				</table>
			</td>
		</tr>
		<!-- Service Details -->
		<tr>
			<td>
				<table border="0" cellpadding="0" cellspacing="0" width="100%">
					<tr>
						<td bgcolor="#b4b4e1" style="font-size: 12px;font-weight: bold; padding: 5px 3px;">
							<span style="display:inline-block;border-bottom:1px solid black; padding-bottom:0px;margin-bottom: 0px">SERVICE DETAILS</span>
						</td>
					</tr>
					<tr><td height="3"></td></tr>
					<tr>
						<td>
							<table border="0" cellpadding="0" cellspacing="0" width="100%">
								<tr>
									<td width="35%" style="font-size: 11px;">1. Subscription/Contract Period : </td>
									<td style="width: 20px;border:1px solid #000"><span>
										@if( $package->contract == "12")
										<img src="{{ url('/assets/tick.png') }}" style="width:14px; height:auto">
										@endif
									</span></td>
									<td width="5">&nbsp;</td>
									<td width="15%" style="font-size: 11px;"> 12 months</td>
									<td style="width: 20px;border:1px solid #000"><span>
										@if( $package->contract == "24")
										<img src="{{ url('/assets/tick.png') }}" style="width:14px; height:auto">
										@endif
									</span></td>
									<td width="5">&nbsp;</td>
									<td width="40%" style="font-size: 11px;"> 24 months</td>
								</tr>
							</table>
						</td>
					</tr>
					<tr><td height="10"></td></tr>
					<tr>
						<td>
							<table border="0" cellpadding="0" cellspacing="0" width="100%">
								<tr>
									<td width="35%" style="font-size: 11px;">2. Required For Service : </td>
									<td width="65%" height="16" style="font-size: 11px;border:1px solid #000"><span>{{ $package->rfs }}</span></td>
								</tr>
							</table>
						</td>
					</tr>
					<tr><td height="8"></td></tr>
					<tr>
						<td>
							<table border="0" cellpadding="0" cellspacing="0" width="100%">
								<tr>
									<td style="font-size: 10px;font-style: italic">1. Standard contract period is 24 months unless otherwise stated</td>
								</tr>
								<tr>
									<td style="font-size: 10px;font-style: italic">2. Required For Service (RFS) is subject to the avaiability of required infrastructure and/or equipment</td>
								</tr>
								<tr>
									<td style="font-size: 10px;font-style: italic">3. Early termination will subject to RM 500 penalty.</td>
								</tr>
							</table>
						</td>
					</tr>
					<tr><td height="8"></td></tr>
					<tr>
						<td>
							<table border="0" cellpadding="0" cellspacing="0">
								<tr>
									<td height="20" width="200" style="font-size: 10px;border:1px solid #000;padding: 5px 3px;font-style: italic">Remarks</td>
								</tr>
							</table>
						</td>
					</tr>
					<tr><td height="2"></td></tr>
				</table>
			</td>
		</tr>
		<!-- Service Details -->
		<tr>
			<td>
				<table border="0" cellpadding="0" cellspacing="0" width="100%">
					<tr>
						<td bgcolor="#b4b4e1" style="font-size: 12px;font-weight: bold; padding: 5px 3px;">
							<span style="display:inline-block;border-bottom:1px solid black; padding-bottom:0px;margin-bottom: 0px">PACKAGE DETAILS</span>
						</td>
					</tr>
					<tr><td height="5"></td></tr>
					<tr>
						<td>
							<table border="0" cellpadding="0" cellspacing="0" width="100%">
								<tr>
									<td style="font-size: 11px;font-weight: bold">1. City Broadband Residental (Best Effort Bandwith)</td>
								</tr>
							</table>
						</td>
					</tr>
					<tr><td height="5"></td></tr>
					<tr>
						<td>
							<table border="0" cellpadding="0" cellspacing="0" width="100%">
								@if(strpos($created_at, '2018') !== false)
								<tr>
									<td width="13" height="13" style="border:1px solid black;">
										<span>
											@if( $package->name == '100')
											<img src="{{ url('/assets/tick.png') }}" style="width:14px; height:auto">
											@endif
										</span>
									</td>
									<td width="5">&nbsp;</td>
									<td style="font-size: 11px;"><b>100Mbps</b></td>
									<td width="10">&nbsp;</td>
									<td style="font-size: 11px;"><b>RM 109</b> ( RM 115.54 )</td>
									<td>&nbsp;</td>
								</tr>
								<tr>
									<td width="13" height="13" style="border:1px solid black;">
										<span>
											@if( $package->name == '300')
											<img src="{{ url('/assets/tick.png') }}" style="width:14px; height:auto">
											@endif
										</span>
									</td>
									<td width="5">&nbsp;</td>
									<td style="font-size: 11px;"><b>300Mbps</b></td>
									<td width="10">&nbsp;</td>
									@if(strpos($created_at, '10') !== false || strpos($created_at, '11') !== false || strpos($created_at, '12') !== false)
									<td style="font-size: 11px;"><b>RM 149</b> ( RM 157.94 )</td>
									@else
									<td style="font-size: 11px;"><b>RM 169</b> ( RM 179.14 )</td>
									@endif
									<td>&nbsp;</td>
								</tr>
								<tr>
									<td width="13" height="13" style="border:1px solid black;">
										<span>
											@if( $package->name == '500')
											<img src="{{ url('/assets/tick.png') }}" style="width:14px; height:auto">
											@endif
										</span>
									</td>
									<td width="5">&nbsp;</td>
									<td style="font-size: 11px;"><b>500Mbps</b></td>
									<td width="10">&nbsp;</td>
									@if(strpos($created_at, '10') !== false || strpos($created_at, '11') !== false || strpos($created_at, '12') !== false)
									<td style="font-size: 11px;"><b>RM 239</b> ( RM 253.34 )</td>
									@else
									<td style="font-size: 11px;"><b>RM 259</b> ( RM 274.54 )</td>
									@endif
									<td>&nbsp;</td>
								</tr>
								<tr>
									<td width="13" height="13" style="border:1px solid black;">
										<span>
											@if( $package->name == '1')
											<img src="{{ url('/assets/tick.png') }}" style="width:14px; height:auto">
											@endif
										</span>
									</td>
									<td width="5">&nbsp;</td>
									<td style="font-size: 11px;"><b></b></td>
									<td width="10">&nbsp;</td>
									@if(strpos($created_at, '10') !== false || strpos($created_at, '11') !== false || strpos($created_at, '12') !== false)
									<td style="font-size: 11px;"><b>RM 379</b> ( RM 401.74 )</td>
									@else
									<td style="font-size: 11px;"><b>RM 399</b> ( RM 422.94)</td>
									@endif
									<td>&nbsp;</td>
								</tr>
								@else
									@if((($package->montly_fee == '1 Month FREE' && $package->contract == '24') || ($package->name == '500' && $package->contract == '24')) && ($created >= '2019-12-12' && $created <= '2020-01-31'))
										@foreach($product as $p)
										<tr>
											<td width="13" height="13" style="border:1px solid black;">
												<span>
													@if( $package->name == $p->speed )
													<img src="{{ url('/assets/tick.png') }}" style="width:14px; height:auto">
													@endif
												</span>
											</td>
											<td width="5">&nbsp;</td>
											<td style="font-size: 11px;"><b>{{ $p->package_name }}</b></td>
											<td width="10">&nbsp;</td>
											@if( $p->promotion_price  != '0' && $package->contract == "24")
											<td style="font-size: 11px;">
												<span style="text-decoration: line-through;">
													<b>RM {{ $p->retail_price }}</b> ( RM {{ number_format(floatval($p->retail_price) * 1.06, 2) }} )
												</span>
												<b>RM {{ $p->promotion_price }}</b> ( RM {{ number_format(floatval($p->promotion_price) * 1.06, 2) }} )
											</td>
											@elseif($p->promotion_price  == '0')
												@if($p->speed == '500')
													<td style="font-size: 11px;">
														<span style="text-decoration: line-through;">
															<b>RM {{ $p->retail_price }}</b> ( RM {{ number_format(floatval($p->retail_price) * 1.06, 2) }} )
														</span>
														<b>RM 127</b> ( RM {{ number_format(127 * 1.06, 2) }} )
													</td>
												@else
												<td style="font-size: 11px;"><b>RM {{ $p->retail_price }}</b> ( RM {{ number_format(floatval($p->retail_price) * 1.06, 2) }} )</td>
												@endif
											@endif
											<td>&nbsp;</td>
										</tr>
										@endforeach
									@elseif ($created >= '2020-08-12')
										@foreach($product as $p)
										<tr>
											<td width="13" height="13" style="border:1px solid black;">
												<span>
													@if( $package->name == $p->speed )
													<img src="{{ url('/assets/tick.png') }}" style="width:14px; height:auto">
													@endif
												</span>
											</td>
											<td width="5">&nbsp;</td>
											<td style="font-size: 11px;"><b>{{ $p->package_name }}</b></td>
											<td width="10">&nbsp;</td>
											@if( $p->promotion_price  != '0' && $package->contract == "24")
											<td style="font-size: 11px;">
												<span style="text-decoration: line-through;">
													<b>RM {{ $p->retail_price }}</b> ( RM {{ number_format(floatval($p->retail_price) * 1.06, 2) }} )
												</span>
												<b>RM {{ $p->promotion_price }}</b> ( RM {{ number_format(floatval($p->promotion_price) * 1.06, 2) }} )
											</td>
											@elseif($p->promotion_price  == '0' || $package->contract == "12" )
												<td style="font-size: 11px;"><b>RM {{ $p->retail_price }}</b> ( RM {{ number_format(floatval($p->retail_price) * 1.06, 2) }} )</td>
											@endif
											<td>&nbsp;</td>
										</tr>
										@endforeach
									@else
										@foreach($product as $p)
										<tr>
											<td width="13" height="13" style="border:1px solid black;">
												<span>
													@if( $package->name == $p->speed )
													<img src="{{ url('/assets/tick.png') }}" style="width:14px; height:auto">
													@endif
												</span>
											</td>
											<td width="5">&nbsp;</td>
											<td style="font-size: 11px;"><b>{{ $p->package_name }}</b></td>
											<td width="10">&nbsp;</td>
											<td style="font-size: 11px;"><b>RM {{ $p->retail_price }}</b> ( RM {{ number_format(floatval($p->retail_price) * 1.06, 2) }} )</td>
											<td>&nbsp;</td>
										</tr>
										@endforeach
									@endif
								@endif
							</table>
						</td>
					</tr>
					<tr><td height="4"></td></tr>
					@if ($package->name != '1' && $package->contract == '24' && $created >= '2020-08-12')
						<tr>
							<td style="font-size: 11px;">
								<img src="{{ url('/assets/tick.png') }}" style="width:14px; height:auto"> RM 10 off for 24 months
							</td>
						</tr>
					@endif
					<tr>
						<td style="font-size: 9px;font-style: italic">*All prices shown in the bracket include 6% Services Tax (ST)</td>
					</tr>
					<tr><td height="5"></td></tr>
					<tr>
						<td>
							<table border="0" cellpadding="0" cellspacing="0" width="100%">
								<tr>
									<td style="font-size: 11px;font-weight: bold">2. Voice (Home)</td>
								</tr>
							</table>
						</td>
					</tr>
					<tr><td height="5"></td></tr>
					<tr>
						<td>
							<table border="0" cellpadding="0" cellspacing="0">
								<tr>
									<td width="13" height="13" style="border:1px solid black;">
										<span>
											@if($package->voice_fee == "yes" || $package->voice_fee == "Yes" || $package->voice_fee == "YES")
											<img src="{{ url('/assets/tick.png') }}" style="width:14px; height:auto">
											@endif
										</span>
									</td>
									<td width="5">&nbsp;</td>
									<td style="font-size: 11px;"><b>Yes</b></td>
									<td width="25">&nbsp;</td>
									<td width="13" height="13" style="border:1px solid black;">
										<span>
											@if($package->voice_fee == "no" || $package->voice_fee == "No" || $package->voice_fee == "NO")
											<img src="{{ url('/assets/tick.png') }}" style="width:14px; height:auto">
											@endif
										</span>
									</td>
									<td width="5">&nbsp;</td>
									<td style="font-size: 11px;"><b>No</b></td>
								</tr>
							</table>
						</td>
					</tr>
					<tr><td height="20"></td></tr>
					<tr>
						<td>
							<table border="0" cellpadding="0" cellspacing="0" width="100%">
								<tr>
									<td style="font-size: 11px;font-weight: bold;font-style: italic"><u>Advanced Payment</u></td>
								</tr>
								@if($package->montly_fee == '1 Month FREE' && $package->contract == '24')
									<tr>
										<td style="font-size: 11px;">1 Month Fee : <b>1 Month FREE</b></td>
									</tr>
								@else
									<tr>
										<td style="font-size: 11px;">1 Month Fee : <b>RM {{ $package->montly_fee }}</b> (including 6% ST)</td>
									</tr>
								@endif
								<tr>
									<td style="font-size: 11px;">Deposit Fee : <b>RM {{ $package->deposit }}</b></td>
								</tr>
								<tr>
									@if($package->voice_fee == "no" || $package->voice_fee == "No" || $package->voice_fee == "NO")
									<td style="font-size: 11px;">Voice Fee : <b>RM 0.00</b></td>
									@elseif($package->voice_fee == "yes" || $package->voice_fee == "Yes" || $package->voice_fee == "YES")
										@if($created >= '2020-08-12')
										<td style="font-size: 11px;">Voice Fee : <b>RM 21.20</b>  (including 6% ST)</td>
										@else
										<td style="font-size: 11px;">Voice Fee : <b>RM 21.20</b> (including 6% ST)</td>
										@endif
									@endif
								</tr>
								<tr>
									<td style="font-size: 11px;">One Time Charge Fee : <b>RM {{ (float)$package->upfront_payment}}</b> (including 6% ST)</td>
								</tr>
								@if($package->montly_fee == '1 Month FREE' && $package->contract == '24')
									<tr>
										<td style="font-size: 11px;">Total : <b>RM {{ number_format(floatval($package->deposit) + floatval($package->voice_fee) + (float)$package->upfront_payment * 1.06, 2) }}</b></td>
									</tr>
								@else
									<tr>
									@if($package->voice_fee == "yes" || $package->voice_fee == "Yes" || $package->voice_fee == "YES")
										<td style="font-size: 11px;">Total : <b>RM {{ number_format(floatval($package->montly_fee) + floatval($package->deposit) + 21.20 + (float)$package->upfront_payment, 2) }}</b></td>
									@else
										<td style="font-size: 11px;">Total : <b>RM {{ number_format(floatval($package->montly_fee) + floatval($package->deposit) + (float)$package->upfront_payment, 2) }}</b></td>
									@endif
									</tr>
								@endif
								<tr>
									<td style="font-size: 9px;">*Installation fee will be woved for permises with available of required infrastructure</td>
								</tr>
								<tr>
									<td style="font-size: 9px;">**Deposit is refundable</td>
								</tr>
							</table>
						</td>
					</tr>
					<tr><td height="20"></td></tr>
				</table>
			</td>
		</tr>
		<!-- Document -->
		<tr>
			<td>
				<table border="0" cellpadding="0" cellspacing="0" width="100%">
					<tr>
						<td bgcolor="#b4b4e1" style="font-size: 12px;font-weight: bold; padding: 5px 3px;">
							<span style="display:inline-block;border-bottom:1px solid black; padding-bottom:0px;margin-bottom: 0px">DOCUMENTS AND DECLARATION</span>
						</td>
					</tr>
					<tr><td height="5"></td></tr>
					<tr>
						<td style="font-size: 11px;"><b>Documents Required:</b></td>
					</tr>
					<tr><td height="5"></td></tr>				
					<tr>
						<td>
							<table border="0" cellpadding="0" cellspacing="0">
								<tr>
									<td width="12" height="12" style="border:1px solid black"><span><img src="{{ url('/assets/tick.png') }}" style="width:14px; height:auto"></span></td>
									<td width="5">&nbsp;</td>
									<td style="font-size: 11px;">Photocopy of MyKad (both sides) or passport (Non-Malaysian)</td>
								</tr>
							</table>
						</td>
					</tr>
					<tr><td height="5"></td></tr>
					<tr>
						<td style="font-size: 11px;"><b>Declarations:</b></td>
					</tr>
					<tr><td height="5"></td></tr>	
					<tr>
						<td>
							<table border="0" cellpadding="0" cellspacing="0">
								<tr>
									<td style="font-size: 12px;text-align: justify"><div style="width:16px;height:16px;border:1px solid black;float:left;margin-right: 3px;"><img src="{{ url('/assets/tick.png') }}" style="width:14px; height:auto"></div>I hereby consent to the collection, use, disclosure of my personal information in accordance with the PRIVACY POLICY available on www.citybroadband.my</td>
								</tr>
								<tr><td height="10"></td></tr>
								<tr>
									<td style="font-size: 12px;text-align: justify"><div style="width:16px;height:16px;border:1px solid black;float:left;margin-right: 3px;"><img src="{{ url('/assets/tick.png') }}" style="width:14px; height:auto"></div> I hereby declare that the above information, documents and any appendices attached are true and valid. I have read and undertood the consent of this form and agreed to be bound by TERMS & CONDITIONS as stated on the next page of this form which accompany the subscription of product(s) and/or service(s). Allo Technology Sdn Bhd reserve the rights to refuse any application at any given time should any of the information is incorrect.</td>
								</tr>
								<tr><td height="10"></td></tr>
								<tr>
									<td style="font-size: 12px;text-align: justify"><div style="width:16px;height:16px;border:1px solid black;float:left;margin-right: 3px;"><img src="{{ url('/assets/tick.png') }}" style="width:14px; height:auto"></div> By signing this document, I agree and accept TERMS & CONDITIONS stipulated herein. I declare that the information provided by me is true and valid. Allo Technology Sdn Bhd reserve the rights to refuse my application at any given time without any refund or whatever monies held by Allo Technology Sdn Bhd should any of the above informationis found to be incorrect. If the service is offered to me, I declare to be bound by the TERMS & CONDITIONS of the service herein</td>
								</tr>
							</table>
						</td>
					</tr>
				</table>
			</td>
		</tr>
		<!-- Signature -->
		<tr>
			<td>
				<table border="0" cellpadding="0" cellspacing="0">
					<tr><td height="15"></td></tr>
					<tr>
						<td width="150" bgcolor="#b4b4e1" style="font-size: 10px;font-weight:bold;font-style: italic; padding: 5px 3px;">
							<span style="display:inline-block; padding-bottom:0px;margin-bottom: 0px">APPLICATION ACKNOWLEDGEMENT</span>
						</td>
					</tr>
					<tr>
						<td height="100" style="border:1px solid black;padding: 5px 3px;">
							<span> 
								@if($form->signature != "")
									<img src="{{ url($form->signature) }}" style="width:300px; height:auto">
								@endif
							</span>
						</td>
					</tr>
					<tr>
						<td style="font-size: 11px;"><b>Submitted Date: {{ $form->Form->created_at }}</b></td>
					</tr>
				</table>
			</td>
		</tr>
	</table>
@if ($ext1 !="pdf" && $ext2 !="pdf" && $ext3 !="pdf" && $ext4 !="pdf" && $ext5 != "pdf" && $ext6 !="pdf")
	@if($form->back_ic != "" && $form->front_ic != "")
		<!-- <div class="page-break"></div> -->
			<table border="0" cellpadding="0" cellspacing="0" width="100%">
				<tr>
					<td>
						<table border="0" cellpadding="0" cellspacing="0" width="100%">
							<tr>
								<td align="center" style="font-size: 16; font-weight: bold;">
									Attachment
								</td>
							</tr>
							<tr><td height="10"></td></tr>
							@if($ext1 !="pdf")
							<tr>
								<td style="font-size: 14; font-weight: bold;">
									Identity Card (Front)
								</td>
							</tr>
							<tr><td height="5"></td></tr>
							<tr>
								<td width="100%" style="text-align: center">
									<img style="display:block;max-width:700px;max-height:500px" src="{{ url($form->front_ic) }}">
								</td>
							</tr>
							@endif
							<tr><td height="5"></td></tr>
							@if($ext2 !="pdf")
							<tr>
								<td style="font-size: 14; font-weight: bold;">
									Identity Card (Back)
								</td>
							</tr>
							<tr><td height="5"></td></tr>
							<tr>
								<td width="100%" style="text-align: center">
									<img style="display:block;max-width:700px;max-height:500px" src="{{ url($form->back_ic) }}">
								</td>
							</tr>
							@endif
						</table>
					</td>
				</tr>
				@if($form->visaF != "" && $form->visaB != "")
				<tr>
					<td>
						<table border="0" cellpadding="0" cellspacing="0" width="100%">
							@if($ext3 !="pdf")
							<tr>
								<td style="font-size: 14; font-weight: bold;">
									Visa (Front)
								</td>
							</tr>
							<tr><td height="5"></td></tr>
							<tr>
								<td width="100%" style="text-align: center">
									<img style="display:block;max-width:700px;max-height:500px" src="{{ url($form->visaF) }}">
								</td>
							</tr>
							@endif
							<tr><td height="5"></td></tr>
							@if($ext4 !="pdf")
							<tr>
								<td style="font-size: 14; font-weight: bold;">
									Visa (Back)
								</td>
							</tr>
							<tr><td height="5"></td></tr>
							<tr>
								<td width="100%" style="text-align: center">
									<img style="display:block;max-width:700px;max-height:500px" src="{{ url($form->visaB) }}">
								</td>
							</tr>
							@endif
						</table>
					</td>
				</tr>
				@endif
				@if($form->paymentReceipt != "" && $ext5 !="pdf")
				<tr>
					<td>
						<table border="0" cellpadding="0" cellspacing="0" width="100%">
							<tr>
								<td style="font-size: 14; font-weight: bold;">
									Upfront Payment Receipt
								</td>
							</tr>
							<tr><td height="5"></td></tr>
							<tr>
								<td width="100%" style="text-align: center">
									<img style="display:block;max-width:700px;max-height:500px" src="{{ url($form->paymentReceipt) }}">
								</td>
							</tr>
						</table>
					</td>
				</tr>
				@endif
				@if($form->soForm != "" && $ext6 !="pdf")
				<tr>
					<td>
						<table border="0" cellpadding="0" cellspacing="0" width="100%">
							<tr>
								<td style="font-size: 14; font-weight: bold;">
									Service Order Form
								</td>
							</tr>
							<tr><td height="5"></td></tr>
							<tr>
								<td width="100%" style="text-align: center">
									<img style="display:block;max-width:700px;max-height:500px" src="{{ url($form->soForm) }}">
								</td>
							</tr>
						</table>
					</td>
				</tr>
				@endif
			</table>	
	@endif
@endif
</body>
</html>
