eid application form borang pendaftaran eid · pdf filechairman’s presentation...

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1. I understand that as a eXfuze Entrepreneurial Independent Distributor (EID): (i) I have the right to offer for sale eXfuze range of products and income opportunity in accordance with these Terms and Conditions. (ii) I have the right to enroll individuals and business entities into eXfuze an EID. (iii) I will train and motivate the EIDs in my downline sales team organization. (iv) I will comply with all federal, state, and local laws, rules and regulations, and shall make all reports and remit all withholdings or other deductions as may be required by federal, state, and local laws. (v) I will perform my obligations as an EID with the utmost honesty and integrity. 2. I agree to present the business opportunity and eXfuze range of products and services as set forth on the corporate website located at www.exfuze.my. 3. I agree that as an Independent Distributor I am an independent contractor, and not an employee, agent, partner, legal representative or franchisee of eXfuze. I am not authorized to and will not incur any debt, expense, obligation, or open any checking account on behalf of, for, or in the name of eXfuze or eXfuze™. I agree that I will be solely responsible for paying all expenses incurred by myself, including but not limited to travel, food, lodging, secretarial, office, local or long distance telephone calls or faxes, and other expenses. I UNDERSTAND THAT I SHALL NOT BE TREATED AS AN EMPLOYEE OF EXFUZE FOR ANY LEGAL PURPOSES. eXfuze is not responsible for withholding, and shall not withhold or deduct from my bonuses and commissions, if any, for payment of any taxes. 4. I have carefully read and agree to comply with the eXfuze Policies and Procedures and the eXfuze Compensation Program, Located on the eXfuze corporate website at www.exfuze.my. (These two documents shall be collectively referred to as the “EID Agreement”). I understand that I must be in good standing, and not in violation of the EID Agreement to be eligible for bonuses or commissions from eXfuze as outlined in the compensation program. I understand the eXfuze Terms and Conditions, the eXfuze Policies and Procedures, and the eXfuze Compensation Program may be amended at the sole discretion of eXfuze, and I agree that any such amendment will apply to me. Notification of amendments shall be published in official eXfuze materials including the corporate website at www.exfuze.my. Amendments shall become effective at time of publication. The continua- tion of my EID business or my acceptance of bonuses or commissions shall constitute my acceptance of any and all amendments. 5. The term of the EID agreement is one calendar year from date of enrollment as an EID. Failure to annually renew my EID business enrollment with eXfuze as per Clause 6 below, I will permanently lose all rights as an EID. I shall not be eligible to sell eXfuze range of products or services nor shall I be eligible to receive commissions, bonuses or other income resulting from the activities of my former downline sales team organization. In the event of cancellation, termination or non-renewal, I waive all rights, including, but not limited to, all future property rights to my former downline sales team organization and to any bonuses, commissions or other incentives in any forms derived through the personal or/and group sales and other activities of my former downline sales team organization. eXfuze reserves the right to terminate all EID Agreements upon 30 days’ notice if the Company elects to: (1) cease business operations, (2) dissolve as a business entity or, (3) terminate distribution of its products and/or income opportunity via direct selling channels. 6. I understand that the term of my EID business enrollment is one calendar year. My yearly Back Office Online Access renewal fee of RM70.00 is payable to eXfuze on or after my anniversary enrollment date. The annual renewal fee is subject to change based on promotions eXfuze may choose, at its discretion to offer. 7. I may not assign any rights or delegate my duties under the EID Agreement without the prior written consent of eXfuze. Any attempt to transfer or assign the EID Agreement without the express written consent of eXfuze renders the EID Agreement voidable at the option and final decision of eXfuze and may result in termination of my business or my distributorship. 8. I understand that if I fail to comply with the terms and conditions of the EID Agreement, eXfuze may, at its discretion, impose upon me disciplinary action as set forth in the Policies and Procedures. If I am in breach, default, or violation of the EID Agreement at termination, I shall not be entitled to receive any further bonuses or commissions, whether or not the sales for such bonuses or commissions have been completed. 9. Distributors who wish to terminate their distributorship voluntarily or involuntarily are free to return all the company’s product purchased back to the company. a) The company will accept back all return products valid six (6) months from the date of purchased by the distributors. b) All products return must be in good condition and must be in a saleable condition. c) The refund amount will be return to the distributor within 30 days from the date of return 10. eXfuze, its directors, officers, shareholders, charter members, associates, employees, assigns and agents (collectively referred to as “affiliates”), shall not be liable for, and I fully release eXfuze and its affiliates, from all claims for consequential and exemplary damages. I further agree to release eXfuze and its affiliates from all liability arising from or relating to the promotion or operation of my EID business and any activities related to it (e.g., the presentation of eXfuze range of products or the Business Compensation Program, the operation of a motor vehicle, the lease of meeting or training facilities etc.), and agree to indemnify eXfuze for any liability, fines, penalties or other awards arising from any unauthorized conduct that I undertake in operating my EID business. 11. The EID Agreement in its current form and as amended by eXfuze from time to time at its discretion, constitutes the entire contract between eXfuze and the EID. Any implied promises, representations, offers or other communications not expressly set forth in the EID Agreement are of no force or effect. 12. Any waiver by eXfuze of any breach of the EID Agreement must be in writing and signed by the director, General Manager or Manager of eXfuze. Waiver by eXfuze of any breach of the EID Agreement by an EID shall not be construed as a waiver of any subsequent breach that may occur while operating their EID business. 13. If any provision of the EID Agreement is held to be invalid or unenforceable, such provision shall be reformed only to the extent necessary to make it enforceable and the balance of the EID Agreement will remain in full force and effect. 14. This EID Agreement will be governed by and construed in accordance with the laws of Malaysia, without regard to principles of conflicts of laws. All disputes and claims relating to eXfuze, EID Agreement, Policies, Procedures, Terms and Conditions, Compensation Program or its products and business opportunity, the rights and obligations of an EID and eXfuze, or any other claims or causes of action relating to the performance of either an EID under the EID Agreement of the eXfuze Policies and Procedures shall be settled totally and finally by arbitration in Malaysia. The decision of the arbitrator shall be final and binding on the parties and may, if necessary, be reduced to a judgment in any court of jurisdiction. The prevailing party shall be entitled to receive from the losing party, according to the decision of the arbitrator, costs and expenses, including legal and filing fees. The provision to arbitrate shall survive any termination or expiration of the EID Agreement. Nothing in the EID Agreement shall prevent eXfuze from applying to and obtaining from any court having jurisdiction a writ of attachment, a temporary injunction, preliminary injunction, permanent injunction or other relief available to safeguard and protect eXfuze’s interest prior to, during or following the filing of any arbitration or other proceeding or pending the rendition of a decision or award in connection with any arbitration or other pending proceeding. 15. The parties consent to jurisdiction and venue before any federal or state court in Malaysia, for purposes of enforcing an award by an arbitrator or any other matter not subject to arbitration. 16. If a Distributor wishes to bring an action against eXfuze for any act or omission relating to or arising from the EID Agreement, such action must be brought within one year from the date of the alleged conduct giving rise to the cause of action. Failure to bring such action within such time shall bar all claims against eXfuze and its affiliates for such act or omission. Distributor waives all claims that any other statutes of limitations applies. 17. I authorize eXfuze to use my name, NRIC Number, photograph, personal story and/or likeness in advertising or promotional materials and waive all claims for compensation for such use. 18. A faxed copy (together with copy of applicant’s NRIC and business registration form if applicable) of the EID Agreement shall be treated as original in all respects. A signed EID Agreement attached with copy of NRIC and other supporting documents must be on file at eXfuze for each EID before commissions earned will be issued. 19. I further agree to abide and comply with the rules and regulations governing the multi-level marketing and direct sales as stipulated in the Direct Selling Act 1993 of Malaysia. I, , NRIC No: agree to the Terms and Conditions, Policies and Procedures, EID Agreement of an Independent Business Distributor of eXfuze as indicated with this application and on the company website at www.exfuze.my and give permission to eXfuze to process this Application. TERMS AND CONDITIONS for a eXfuze Entrepreneurial Independent Distributor (Thereinafter refers as “EID”) eXfuze Malaysia Sdn Bhd (760223-T) (AJL 931726) (GST ID NO. 001376174080) (Thereinafter refers as “eXfuze”) MALAYSIA EID APPLICATION FORM BORANG PENDAFTARAN EID 会员注册表格 NAME / NAMA 姓名: NEW EID / NO.EID BARU 会员帐号: ORDER ID / NO. PESANAN BARU 订单号码: PLEASE SELECT YOUR PREFERRED LANGUAGE / SILA PILIH BAHASA ANDA 请选择您的首选语言 eXfuze Malaysia Sdn Bhd (760223-T) (AJL 931726) (GST ID NO. 001376174080) Lot 11, Jalan 51A/223, Seksyen 51A, 46100 Petaling Jaya, Selangor, Malaysia. Tel电话: (+603) 7960 1877 Fax传真: (+603) 7960 2877 www.exfuze.my English Inggeris 英语 Malay Bahasa Melayu 马来语 Chinese Bahasa Cina 华语 Please refer TERMS & CONDITIONS in Malay or Chinese version at Back Office>Print Material Page. Sila rujuk terma dan syarat dalam Bahasa Malaysia atau Bahasa Cina dari Back Office > Pencetakan Dokumen (Print Material Page) 请到模拟工作室 (Back Office)> 文件打印 (Print Material Page) 以参阅马来版或中文版条款和条例 VCN-092.16-v1-CHRMNEIDAPPFORM-MYS.enu

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Page 1: EID APPLICATION FORM BORANG PENDAFTARAN EID   · PDF fileChairman’s Presentation Presentasi Pengerusi ... IC Number Nombor Kad Pengenalan

1. I understand that as a eXfuze Entrepreneurial Independent Distributor (EID):(i) I have the right to o�er for sale eXfuze range of products and income opportunity in accordance with these Terms and Conditions. (ii) I have the right to enroll individuals and business entities into eXfuze an EID.(iii) I will train and motivate the EIDs in my downline sales team organization.(iv) I will comply with all federal, state, and local laws, rules and regulations, and shall make all reports and remit all withholdings or other deductions as may be required by federal, state, and local laws.(v) I will perform my obligations as an EID with the utmost honesty and integrity.2. I agree to present the business opportunity and eXfuze range of products and services as set forth on the corporate website located at www.exfuze.my.3. I agree that as an Independent Distributor I am an independent contractor, and not an employee, agent, partner, legal representative or franchisee of eXfuze. I am not authorized to and will not incur any debt, expense, obligation, or open any checking account on behalf of, for, or in the name of eXfuze or eXfuze™. I agree that I will be solely responsible for paying all expenses incurred by myself, including but not limited to travel, food, lodging, secretarial, o�ce, local or long distance telephone calls or faxes, and other expenses. I UNDERSTAND THAT I SHALL NOT BE TREATED AS AN EMPLOYEE OF EXFUZE FOR ANY LEGAL PURPOSES. eXfuze is not responsible for withholding, and shall not withhold or deduct from my bonuses and commissions, if any, for payment of any taxes.4. I have carefully read and agree to comply with the eXfuze Policies and Procedures and the eXfuze Compensation Program, Located on the eXfuze corporate website at www.exfuze.my. (These two documents shall be collectively referred to as the “EID Agreement”). I understand that I must be in good standing, and not in violation of the EID Agreement to be eligible for bonuses or commissions from eXfuze as outlined in the compensation program. I understand the eXfuze Terms and Conditions, the eXfuze Policies and Procedures, and the eXfuze Compensation Program may be amended at the sole discretion of eXfuze, and I agree that any such amendment will apply to me. Noti�cation of amendments shall be published in o�cial eXfuze materials including the corporate website at www.exfuze.my. Amendments shall become e�ective at time of publication. The continua- tion of my EID business or my acceptance of bonuses or commissions shall constitute my acceptance of any and all amendments.5. The term of the EID agreement is one calendar year from date of enrollment as an EID. Failure to annually renew my EID business enrollment with eXfuze as per Clause 6 below, I will permanently lose all rights as an EID. I shall not be eligible to sell eXfuze range of products or services nor shall I be eligible to receive commissions, bonuses or other income resulting from the activities of my former downline sales team organization. In the event of cancellation, termination or non-renewal, I waive all rights, including, but not limited to, all future property rights to my former downline sales team organization and to any bonuses, commissions or other incentives in any forms derived through the personal or/and group sales and other activities of my former downline sales team organization. eXfuze reserves the right to terminate all EID Agreements upon 30 days’ notice if the Company elects to:(1) cease business operations,(2) dissolve as a business entity or,(3) terminate distribution of its products and/or income opportunity via direct selling channels.6. I understand that the term of my EID business enrollment is one calendar year. My yearly Back O�ce Online Access renewal fee of RM70.00 is payable to eXfuze on or after my anniversary enrollment date. The annual renewal fee is subject to change based on promotions eXfuze may choose, at its discretion to o�er.7. I may not assign any rights or delegate my duties under the EID Agreement without the prior written consent of eXfuze. Any attempt to transfer or assign the EID Agreement without the express written consent of eXfuze renders the EID Agreement voidable at the option and �nal decision of eXfuze and may result in termination of my business or my distributorship.8. I understand that if I fail to comply with the terms and conditions of the EID Agreement, eXfuze may, at its discretion, impose upon me disciplinary action as set forth in the Policies and Procedures. If I am in breach, default, or violation of the EID Agreement at termination, I shall not be entitled to receive any further bonuses or commissions, whether or not the sales for such bonuses or commissions have been completed.9. Distributors who wish to terminate their distributorship voluntarily or involuntarily are free to return all the company’s product purchased back to the company.a) The company will accept back all return products valid six (6) months from the date of purchased by the distributors.b) All products return must be in good condition and must be in a saleable condition.c) The refund amount will be return to the distributor within 30 days from the date of return10. eXfuze, its directors, o�cers, shareholders, charter members, associates, employees, assigns and agents (collectively referred to as “a�liates”), shall not be liable for, and I fully release eXfuze and its a�liates, from all claims for consequential and exemplary damages. I further agree to release eXfuze and its a�liates from all liability arising from or relating to the promotion or operation of my EID business and any activities related to it (e.g., the presentation of eXfuze range of products or the Business Compensation Program, the operation of a motor vehicle, the lease of meeting or training facilities etc.), and agree to indemnify eXfuze for any liability, �nes, penalties or other awards arising from any unauthorized conduct that I undertake in operating my EID business.11. The EID Agreement in its current form and as amended by eXfuze from time to time at its discretion, constitutes the entire contract between eXfuze and the EID. Any implied promises, representations, o�ers or other communications not expressly set forth in the EID Agreement are of no force or e�ect.12. Any waiver by eXfuze of any breach of the EID Agreement must be in writing and signed by the director, General Manager or Manager of eXfuze. Waiver by eXfuze of any breach of the EID Agreement by an EID shall not be construed as a waiver of any subsequent breach that may occur while operating their EID business.13. If any provision of the EID Agreement is held to be invalid or unenforceable, such provision shall be reformed only to the extent necessary to make it enforceable and the balance of the EID Agreement will remain in full force and e�ect.14. This EID Agreement will be governed by and construed in accordance with the laws of Malaysia, without regard to principles of con�icts of laws. All disputes and claims relating to eXfuze, EID Agreement, Policies, Procedures, Terms and Conditions, Compensation Program or its products and business opportunity, the rights and obligations of an EID and eXfuze, or any other claims or causes of action relating to the performance of either an EID under the EID Agreement of the eXfuze Policies and Procedures shall be settled totally and �nally by arbitration in Malaysia. The decision of the arbitrator shall be �nal and binding on the parties and may, if necessary, be reduced to a judgment in any court of jurisdiction. The prevailing party shall be entitled to receive from the losing party, according to the decision of the arbitrator, costs and expenses, including legal and �ling fees. The provision to arbitrate shall survive any termination or expiration of the EID Agreement. Nothing in the EID Agreement shall prevent eXfuze from applying to and obtaining from any court having jurisdiction a writ of attachment, a temporary injunction, preliminary injunction, permanent injunction or other relief available to safeguard and protect eXfuze’s interest prior to, during or following the �ling of any arbitration or other proceeding or pending the rendition of a decision or award in connection with any arbitration or other pending proceeding.15. The parties consent to jurisdiction and venue before any federal or state court in Malaysia, for purposes of enforcing an award by an arbitrator or any other matter not subject to arbitration.16. If a Distributor wishes to bring an action against eXfuze for any act or omission relating to or arising from the EID Agreement, such action must be brought within one year from the date of the alleged conduct giving rise to the cause of action. Failure to bring such action within such time shall bar all claims against eXfuze and its a�liates for such act or omission. Distributor waives all claims that any other statutes of limitations applies.17. I authorize eXfuze to use my name, NRIC Number, photograph, personal story and/or likeness in advertising or promotional materials and waive all claims for compensation for such use.18. A faxed copy (together with copy of applicant’s NRIC and business registration form if applicable) of the EID Agreement shall be treated as original in all respects. A signed EID Agreement attached with copy of NRIC and other supporting documents must be on �le at eXfuze for each EID before commissions earned will be issued.19. I further agree to abide and comply with the rules and regulations governing the multi-level marketing and direct sales as stipulated in the Direct Selling Act 1993 of Malaysia.

I, , NRIC No: agree to the Terms and Conditions, Policies and Procedures, EID Agreement of an Independent Business Distributor of eXfuze as indicated with this application and on the company website at www.exfuze.my and give permission to eXfuze to process this Application.

TERMS AND CONDITIONS for a eXfuze Entrepreneurial Independent Distributor (Thereinafter refers as “EID”)

eXfuze Malaysia Sdn Bhd (760223-T) (AJL 931726) (GST ID NO. 001376174080) (Thereinafter refers as “eXfuze”) MALAYSIA

EID APPLICATION FORMBORANG PENDAFTARAN EID

会员注册表格

NAME / NAMA 姓名:

NEW EID / NO.EID BARU 会员帐号:

ORDER ID / NO. PESANAN BARU 订单号码:

PLEASE SELECT YOUR PREFERRED LANGUAGE / SILA PILIH BAHASA ANDA 请选择您的首选语言

eXfuze Malaysia Sdn Bhd(760223-T) (AJL 931726) (GST ID NO. 001376174080)

Lot 11, Jalan 51A/223, Seksyen 51A, 46100 Petaling Jaya, Selangor, Malaysia.Tel电话: (+603) 7960 1877 Fax传真: (+603) 7960 2877 www.exfuze.my

English Inggeris 英语 Malay Bahasa Melayu 马来语 Chinese Bahasa Cina 华语

Please refer TERMS & CONDITIONS in Malay or Chinese version at Back O�ce>Print Material Page.Sila rujuk terma dan syarat dalam Bahasa Malaysia atau Bahasa Cina dari Back O�ce > Pencetakan Dokumen (Print Material Page)请到模拟工作室 (Back Office)> 文件打印 (Print Material Page) 以参阅马来版或中文版条款和条例

VCN-092.16-v1-CHRMNEIDAPPFORM-MYS.enu

Page 2: EID APPLICATION FORM BORANG PENDAFTARAN EID   · PDF fileChairman’s Presentation Presentasi Pengerusi ... IC Number Nombor Kad Pengenalan

To become a member of the eXfuze Chairman’s Clubyou need to simply purchase a Chairman’s Pak. It’s that simple.

Untuk menjadi ahli Kelab Pengerusi eXfuze ini, anda hanya perlu membeli Chairman’s Pak. Ia begitu mudah.要成为eXfuze主席俱乐部成员,您只需购买一份Chairman’s包装。就这么简单。

CHAIRMAN’S PAKCHAIRMAN’S 包装

2 Classic Travel Pak 2瓶Classic旅游包装 (20 Bottle/Botol瓶-96ml毫升)

4 Green Summa Café 4罐Green Summa Café (4 Can/Tin罐-222ml毫升)

Green Summa Cylinder Silinder Green Summa / Green Summa透明小装瓶

Chairman’s Marketing Tools Alat Pemasaran Pengerusi 主席营销工具

Chairman’s Event Tickets Tiket Aktiviti Pengerusi 主席活动门票

Chairman’s Presentation Presentasi Pengerusi 主席演示

Chairman’s Member Card Kad Keahlian Pengerusi 主席俱乐部会员卡

Chairman’s Recognition Pin Pin Pengiktirafan Pengerusi 主席徽章

PERSONAL INFORMATION MAKLUMAT PERIBADI 个人资料

Name (as per IC/Passport) Nama (seperti dalam KP/Pasport) 全名

IC NumberNombor Kad Pengenalan身份证号码

GST Registration NumberNombor pendaftaran GST消费税注册号码

Billing AddressAlamat Bil帐单地址

same as above seperti di atas 与上述相同

Passport Number Nombor pasport 护照号码

(2-12 characters-case sensitive; 2-12 watak; 2-12个字符,有区分大小写) (6-8 characters-case sensitive; 6-8 aksarae; 6-8个字,有大小写区分)

www.exfuze.my/

Contact NumberNombor telefon联系号码

E-mail AddressAlamat Emel 电邮地址

Website NameNama Laman web网站名字

PasswordKata Laluan 密码

Billing AddressAlamat Bil 帐单地址

Enroller’s Name*Nama sponsor 招募人姓名

Placement Upline*Penempatan upline 安置上线

Placement*Penempatan安置

* All fields are requiredSemua medan diperlukan必需填写所有资料

Left Outside Team PlacementPaling luar belah kiri选择安置於左线

Right Outside Team PlacementPaling luar belah kanan选择安置於右线

Enroller’s ID*ID sponsor招募人的会员号码

Placement Upline’s ID*ID Penempatan upline安置上线的会员号码

State Negeri 州

Country Negera 国家Post Code Poskod 邮编City Bandar 城市

State Negeri 州

Country Negera 国家Post Code Poskod 邮编City Bandar 城市

Name To Appear On CardNama Pada Kad会员卡名字

Payment MethodCara pembayaran付款方法

Authorized Signature of CardholderTandatangan Pemegang Kad

持卡人的授权签名

VISAVISA卡

MASTER CARDMASTER卡

DEBIT CARDDEBIT卡

Card Number Nombor kad 信用卡号码

Cardholder’s Name Nama pemegang akaun 持卡人姓名

Account Holder Name Nama pemegang akaun 账户持有人姓名

Account Number Nombor akaun 帐号

Expiration DateTarikh luput 过期日期

Acc TypeJenis Akaun账号类型

Current Acc / Saving Acc / Debit Card AccAkaun semasa / simpanan / debit当前账户/ 储蓄账户/ 转账户

Bank银行

CVV

PAYMENT INFORMATION MAKLUMAT PEMBAYARAN 付款信息

BANK ACCOUNT INFORMATION MAKLUMATAKAUN BANK 银行账户资料

Distributor commission will be paid via Electronic Fund Transfer and deposited directly into the member’s account below. If commission is to be paid to a third party account, please sign Letter of Consent.Komisen pengedar akan dibayar melalui Electronic Fund Transfer dan didepositkan terus ke dalam akaun ahli di bawah. Jika ahli ingin komisen dibayar kepada akaun pihak ketiga, sila lengkapkan Surat Persetujuan.经销商佣金将会通过电子转账支付,并直接存入下述会员账户。如果佣金是支付给第三方帐户,请在同意函签下名字。

PV BV

300 300

Product price/Harga Produk 产品价格: RM1,910.38

EID Application Fee/Yuran keahlian eXfuze 会员申请费:RM70.75

GST 消费税: RM118.87

PRICE HARGA 价钱: RM 2,100.00

Note: Please deposit cash or cheque payment into Public Bank Berhad, Account No: 3140002019 payable to “eXfuze Malaysia Sdn Bhd”.Nota: Sila deposit wang tunai atau cek pembayaran ke dalam akaun Public Bank Berhad, No Akaun: 3140002019 atas nama " eXfuze Malaysia SdnBhd ". 注意事项:请存入现金或以支票支付到 “eXfuze Malaysia Sdn Bhd”大众银行帐号3140002019。

Please be advised that once the product is collected from the counter, it is the sole responsibility of the distributor to keep track of it until they leave the building. eXfuze will not be responsible for any product that is claimed lost, misplaced, missing or stolen once it has been signed and picked up by a distributor. All prices inclusive of 6% Goods & Services Tax (GST).Sila ambil perhatian bahawa apabila produk diambil dari kaunter, ia adalah dibawah tanggungjawab pengedar sehingga keluar bangunan eXfuze. eXfuze tidak akan bertanggungjawab ke atas sebarang produk yang di dakwa hilang, tersalah letak atau dicuri apabila ia telah ditandatangani dan diambil oleh pengedar di kaunter eXfuze. Semua harga termasuk 6% Cukai Barang dan Perkhidmatan (GST).请注意,一旦产品经签署并由经销商从柜台提取,护持产品的责任则全归经销商。请恕eXfuze将不负责一切产品丢失,错放或被盗的责任。所有价格包括6%的商品及服务税(GST)。

Delivery ModeMod Penghantaran 交货方式

Ship Hantar 寄送

Pick up Ambil 现场提货

NOTE: All signatures MUST be supplied or application will be rejected注意:必须提供所有签名否则应用程序将会被驳回

PESANAN: Semua tandatangan MESTI dibekalkan atau permohonan akan ditolak

SignatureTandatangan

签名

DateTarikh日期

VCN-092.16-v1-CHRMNEIDAPPFORM-MYS.enu