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Payment confirmation form

Please use this form when additional payment information are requested by Synergy. The following information is required for identification purposes.

All fields required unless indicated as optional.


Your account and missing payment details
account number

We will need your Synergy account number for this request. You'll find your account number at the top right of your bill or from the email.

If you're adding a landline, don't forget the 2 digit area code. If you're adding a mobile number, it's 10 digits starting with 04.

To upload payment evidence, please select a file first and then select Upload button. All form of payment confirmation or statement must be provided in a non-editable format such as copy of transaction statement issued from financial institution. Word documents, Excel spreadsheets, personal ledgers are not accepted. The total file size for all documents must be less than 20MB. Allowed file types: PDF, JPG, PNG.

Allowed file types: PDF, JPG, PNG

File must be less than 10 MB.

File name : {{file.name}}     File Size : {{((file.size / 1024) / 1024).toFixed(2)}} mb    

* One or more form fields contains errors, please fix the appropriate fields and try again.