Registration Form

Please fill in the form below to complete using BLOCK LETTERS. For any queries, SMS to 011-15021430/012-2569056. THANK YOU!


SPONSOR NAME : JULIZA BINTI JIMAT

SPONSOR CODE : MB0053773K86
FULL NAME * 
(As in MYKAD)
NRIC NO. *
(As in MYKAD)
CORRESPONDENCE ADDRESS *
CONTACT NO. *
E-MAIL ADDRESS *
BANK'S NAME
(For the payment of bonuses)
ACCOUNT NO.
Payment Method Internet Banking (Maybank2u)
Internet Banking (AmOnline)
Interbank Fund Transfer (CIMB Clicks / etc)
Cash Deposit at ATM Machine
Cash Deposit at Bank Counter
Fund Transfer at ATM Machine
PROOF OF PAYMENT
(Please "copy & paste" proof of payment here if you are making payments "online")
Payment Confirmation YES, I Confirm my Order and Commit to make payment within 24 hours from order date. (Joy Buyer AND Unpaid Buyer / Customer will be BLACKLISTED)
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