NONI BSY

MEMBER APPLICATION FORM

PACKAGE : CLASSIC/ SILVER/ GOLD/ MOBILE STOKIST (Please Circle)

ID NO :(Auto Generate by system)

Login password : 123456 (Auto Generate by System)

2^nd password : 123456

Full name :

I/C No:

Sex:

Email :

Nickname id:

Address:

City: Postcode:

Country: fax:

H/Phone.no:

Office no:

Bank Account Information:-

Bank Name: CIMB

Bank Account No:

Sponsor & Placement Information :-

Sponsor id:

Placement id:

Please circle: A / B

I, the above named applicant hereby certify that all the above information are true and correct.

Signature :

Date:

(Interested, please copy & paste to microsoft office word and fill in the form send back to me via email)