Registration Form/Borang Pendaftaran

Section A : Customer Details/Maklumat Pelanggan

Please write in BLOCK letters and tick (/) where applicable

APPLICANT'S NAME

NAMA PEMOHON

ADDRESS

ALAMAT

NRIC

NO K/P

FAX

FAKS

HANDPHONE

TELEFON BIMBIT

E-MAIL ADDRESS

ALAMAT E-MAIL

Section B : Choice Of Product/Produk Pilihan

Pakej Istimewa RM 500 Mobile Income Manager RM 5000

Pakej Istimewa RM 2000 Mobile Income Manager RM 10000