CIBMALL PIF FORM
| *Name/名字: | |
| *Contact Number / 电话: | |
| *E-mail Address/ 电子信箱: | |
| *No. IC / 身份证号码: | |
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| CiBMall ID / CiBMall 账号: | |
| Game Account / 游戏账号: |
| *Game Title / 游戏名称: | |
| *Server / 伺服器: | |
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