No. 5-9B, Level 9, The Boulevard, Mid Valley City, Lingkaran Syed Putra, 59200 Kuala Lumpur.
TEL: 03 - 2201 4696 | FAX : 03 - 2201 3096
 
 
 
Please Download Our Incentive Plan Here
MEMBER APPLICATION FORM 申 请 表 格
* Kindly fill in all particulars in English 所有資料請以英文填寫
(A) APPLICANT'S PARTICULARS 申请人資料
1. Company Name 公司名字 :  
2. Company's Reg. No. 公司注册号码:   (Company's registration & Directors' information need to be attached)
3. Applicant's Name (Mr/Ms/Mdm)
申请者姓名: *
 
4. New NRIC No. 新身份證號碼 : *  
5. Date of Birth 出生日期: *   (dd-mm-yyyy)
6. Occupation 職業:  
7. Languages Spoken 溝通語言:  
BM 国语   English 英语   Chinese 中文
8. Tel 电话:   -
  Mobile 手機: *   -
  Fax 傳真:   -
  Email address: *  
9. Current Correspondence Address
通訊地址: *
 
  Postcode 邮区:  
  Country 国家 : *  
(B) YOUR BANK ACCOUNT 銀行戶口資料
1. BANK / 银行  
  ACCOUNT NO / 银行户口号码 *  
  ACCOUNT HOLDER NAME /
银行户口名字
 
(C) REFFERAL'S DATA 介紹人資料
1. Referral Code 介绍人编号: *  
2 Name (Mr/Mdm/Ms) 姓名: *  
3 Contact No. 聯絡號碼:   -
(D) MEMBERSHIP TERMS & CONDITIONS

I have read, understand and agree with the Terms & Conditions.
 
(E) BUSINESS RULES & REGULATIONS

Do you agree to the Business Rules and Regulations? Yes
 
COMPANY BANK ACCOUNT DETAILS:

ACCOUNT NAME : BIO-YOUNG (M) SDN BHD
BANKER : PUBLIC BANK BERHAD
A/C NO : 3982804008