PLDTHOME APPLICATION FORM
This is a PLDT Service Application Form through a PLDT Accredited HOME Distributor, VEROSERVE CORP. Processing of your application begins only upon the submission of this application form.
SWITCH PROMO FORM
CHOOSE A PLAN
*
Please Select
Fiber Unli Plan 1299 - 50mbps
Fiber Unli All Plan 1399 - 100mbps
Fiber Netflix Plan 1599 - 150mbps
Fiber Unli Plan 1699 - 300mbps
Fiber Unli All Plan 1799 - 300mbps
Fiber Unli Plan 2099 - 500mbps
Fiber Netflix Plan 2499 - 500mbps
Fiber Unli Plan 2699 - 700mbps
Fiber Unli All Plan 3199 - 700mbps
1MSF (One-Month Service Fee) or ADVANCE PAYMENT upon installation.
*
I am willing to pay 1 month advance, this will also serve as my first and second bill payment.
FULLNAME
*
First Name
Middle Name
Last Name
eMAIL ADDRESS
*
example@example.com
BIRTH DATE
*
-
Month
-
Day
Year
Date
IDENTIFICATION CARD
*
Browse Files
Drag and drop files here
Choose a file
PLEASE PROVIDE FRONT AND BACK PHOTOS OF ID. IF YOU DO NOT HAVE A PRIMARY ID, PLEASE PROVIDE TWO (2) SECONDARY IDs. CLEAR, NO REFLECTION, NOT BLURRY WHEN ZOOMED-IN, CAN CLEARLY READ ALL THE INFORMATION.
Cancel
of
STATEMENT OF ACCOUNT (SOA) OR RECEIPTS
*
Browse Files
Drag and drop files here
Choose a file
PLEASE PROVIDE CLEAR PHOTOS OF LATEST SOA OR TWO RECENT RECEIPTS (for the last 3 months)
Cancel
of
SELFIE WITH IDs, SOA or RECEIPTS
*
Browse Files
Drag and drop files here
Choose a file
PLEASE PROVIDE SEPARATE SELFIE WITH YOUR ID AND WITH SOA or RECEIPTS.
Cancel
of
GENDER
*
MALE
FEMALE
CITIZENSHIP
*
FILIPINO
OTHER
MOTHER'S FULL MAIDEN NAME
Pangalan ng Nanay noong dalaga pa. (FIRST NAME, MIDDLE NAME, LAST NAME)
CONTACT NUMBER 1
*
CONTACT NUMBER 2
*
COMPLETE ADDRESS
*
HOUSE NO. / BLOCK & LOT / STREET / SUBDIVISION / VILLAGE
SITIO / PUROK / BARANGAY
TOWN / CITY
PROVINCE
POSTAL / ZIP CODE
LANDMARK
*
e.g. (BRGY. HALL, CHAPEL, SCHOOL, STORE, MARKET, COURT, etc.) You can also include, Google Map's Location (Pinned Location), Long-Lat or GPC Plus Code of your house or building.
Submit
Should be Empty: