APPLICANT INFORMATION / MAKLUMAT PEMOHON |
| Name / Nama :
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| New NRIC No. / No. KP Baru :
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| Date Of Birth / Tarikh Lahir :
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| Nationality / Warganegara :
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| Sex / Jantina :
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Male / Lelaki
Female / Perempuan |
| Terms Of Address / Gelaran Kehormat :
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Encik / Mr
Puan / Mrs
Cik / Ms |
| Marital Status / Status Perkahwinan :
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Single / Bujang
Married / Kahwin
Others / Lain-lain |
| RACE / BANGSA :
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Melayu / Malay
Cina / Chinese
India / Indian
Bumiputra Sabah
Bumiputra Sarawak |
| OCCUPATION / PEKERJAAN :
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BEAUTICIAN / JURUSOLEK
BUSINESSMAN / PENIAGA
EXECUTIVE/SECRETARY / EKSEKUTIF/SETIAUSAHA
GRADUATE / GRADUAN
HOUSEWIFE / SURI RUMAH
LECTURER/TEACHER / PENSYARAH/GURU
MANAGER / PENGURUS
PROFESSIONAL / PROFESIONAL
OTHERS / LAIN-LAIN |
| POSTAL ADDRESS / ALAMAT SURAT MENYURAT :
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| HANDPHONE / TELEFON BIMBIT :
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| Email Address:
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| SAVING OR CURRENT ACCOUNT NO. / NO. AKAUN :
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| BANK NAME / NAMA BANK :
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CIMB BANK
MAYBANK
HONG LEONG BANK BERHAD
MALAYAN BANK BERHAD
PUBLIC BANK |
SPOUSE INFORMATION (MARRIED) / MAKLUMAT PASANGAN (KAHWIN)
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| Name / Nama :
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| New NRIC No. / No. KP Baru :
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| Date Of Birth / Tarikh Lahir :
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BENEFICIARY INFORMATION / MAKLUMAT PEWARIS |
| Name / Nama :
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| New NRIC No. / No. KP Baru :
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| Relationship / Hubungan :
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TO / KEPADA : MELILEA (M) SDN BHD. |
| AGREEMENT / PERJANJIAN :
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I / We wish to apply and become the Distributor of MELILEA (M) SDN BHD with all terms and conditions. / Saya / Kami ingin memohon untuk menjadi Distributor MELILEA (M) SDN BHD. dengan segala terma dan syarat. |
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