Request for modification or notification of changes to the Proximus cable infrastructure in case of renovation or demolition

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All fields are mandatory except those where "optional" is mentioned.

Personal data

Title {{errorMessages.title.required}} {{errorMessages.title.pattern}}

First name {{errorMessages.FirstName.required}} {{errorMessages.FirstName.pattern}} {{errorMessages.FirstName.pattern}} {{errorMessages.FirstName.pattern}} {{errorMessages.FirstName}} {{errorMessages.FirstName.pattern}}

Last name {{errorMessages.LastName.required}} {{errorMessages.LastName.pattern}} {{errorMessages.LastName.pattern}} {{errorMessages.LastName.pattern}} {{errorMessages.LastName}} {{errorMessages.LastName.pattern}}

Please indicate the type of change for which you are requesting intervention:

Removing a Proximus copper cable (the traditional network) from a building with more than 20 residential units. {{errorMessages.infrastructure.required}} {{errorMessages.infrastructure.pattern}}

Replacement of a Proximus copper cable (the traditional network). {{errorMessages.infrastructure.required}} {{errorMessages.infrastructure.pattern}}

Replacing or removing a Proximus fiber optic cable. {{errorMessages.infrastructure.required}} {{errorMessages.infrastructure.pattern}}

Move or remove a Proximus street cabinet in front of the building {{errorMessages.infrastructure.required}} {{errorMessages.infrastructure.pattern}}

Installation address

Region {{errorMessages.region.required}} {{errorMessages.region.pattern}}

Street {{errorMessages.StreetName.required}} {{errorMessages.StreetName.pattern}} {{errorMessages.StreetName.pattern}} {{errorMessages.StreetName.pattern}} {{errorMessages.StreetName}} {{errorMessages.StreetName.pattern}}

Number {{errorMessages.HouseNumber.required}} {{errorMessages.HouseNumber.pattern}} {{errorMessages.HouseNumber.pattern}} {{errorMessages.HouseNumber.pattern}} {{errorMessages.HouseNumber}} {{errorMessages.HouseNumber.pattern}}

Box (optional) {{errorMessages.Letter.required}} {{errorMessages.Letter.pattern}} {{errorMessages.Letter.pattern}} {{errorMessages.Letter.pattern}} {{errorMessages.Letter}} {{errorMessages.Letter.pattern}}

Zip code {{errorMessages.zipCode.required}} {{errorMessages.zipCode.pattern}} {{errorMessages.zipCode.pattern}} {{errorMessages.zipCode.pattern}} {{errorMessages.zipCode}} {{errorMessages.zipCode.pattern}}

City {{errorMessages.cityName.required}} {{errorMessages.cityName.pattern}} {{errorMessages.cityName.pattern}} {{errorMessages.cityName.pattern}} {{errorMessages.cityName}} {{errorMessages.cityName.pattern}}

Contact number {{errorMessages.CALLBACKCLI.required}} {{errorMessages.CALLBACKCLI.pattern}}

Mobile number {{errorMessages.mobile.required}} {{errorMessages.mobile.pattern}} {{errorMessages.mobile.pattern}} {{errorMessages.mobile.pattern}} {{errorMessages.mobile}} {{errorMessages.mobile.pattern}}

Fix number {{errorMessages.fixnumber.required}} {{errorMessages.fixnumber.pattern}} {{errorMessages.fixnumber.pattern}} {{errorMessages.fixnumber.pattern}} {{errorMessages.fixnumber}} {{errorMessages.fixnumber.pattern}}

Email address (for receiving a copy of this order) {{errorMessages.MAILBACKADDR.required}} {{errorMessages.MAILBACKADDR.pattern}} {{errorMessages.MAILBACKADDR.pattern}} {{errorMessages.MAILBACKADDR.pattern}} {{errorMessages.MAILBACKADDR}} {{errorMessages.MAILBACKADDR.pattern}}

Desired execution date of works {{errorMessages.installdate.required}} {{errorMessages.installdate.pattern}} {{errorMessages.installdate.pattern}} {{errorMessages.installdate.pattern}} {{errorMessages.installdate}} {{errorMessages.installdate.pattern}}

Description of works to be carried out {{errorMessages.remarks.required}} {{errorMessages.remarks.pattern}}

Building's Type {{errorMessages.building_type.required}} {{errorMessages.building_type.pattern}}

Type of changes for ‘apartment’

Proximus cables on the façade {{errorMessages.public_infra.required}} {{errorMessages.public_infra.pattern}}

Proximus street cabinet in front of the apartments' building {{errorMessages.public_infra.required}} {{errorMessages.public_infra.pattern}}

Proximus underground cables - from the apartments' building to the street {{errorMessages.public_infra.required}} {{errorMessages.public_infra.pattern}}

Proximus cables in the apartments' building {{errorMessages.public_infra.required}} {{errorMessages.public_infra.pattern}}

Type of change for ‘house’

Proximus cables in the house {{errorMessages.private_infra.required}} {{errorMessages.private_infra.pattern}}

Proximus underground cables - from your house to the street {{errorMessages.private_infra.required}} {{errorMessages.private_infra.pattern}}

Proximus cables on the façade {{errorMessages.private_infra.required}} {{errorMessages.private_infra.pattern}}

Proximus street cabinet in front of your house {{errorMessages.private_infra.required}} {{errorMessages.private_infra.pattern}}

Type of change for ‘commercial building’

Proximus cables in the house {{errorMessages.commercial_infra.required}} {{errorMessages.commercial_infra.pattern}}

Proximus underground cables - from your commercial building to the street {{errorMessages.commercial_infra.required}} {{errorMessages.commercial_infra.pattern}}

Proximus cables on the façade {{errorMessages.commercial_infra.required}} {{errorMessages.commercial_infra.pattern}}

Proximus street cabinet in front of your commercial building {{errorMessages.commercial_infra.required}} {{errorMessages.commercial_infra.pattern}}

I would like to be kept informed about products, services, contests and promotions of Proximus. To this end, Proximus may store my personal data in its files and may contact me, including by phone and via electronic channels such as e-mail, SMS and social media. I’m aware that my data is processed in accordance with Proximus' privacy policy which informs me how to manage my privacy settings.

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