e-Application Form

Full Name as in NRIC		Mobile No
NRIC No		Home No
Correspondence Address		Office No
Income Tax Availability		Tax Resident in Malaysia
Income Tax No		Status in Year
Bank Account Information		Position Applied
Primary Account Holder NRIC No (For Joint Account ONLY)		Agent Code
Bank Name		Agency Code
Bank Account No		GST Registered Agent
Chinese Name		GST No
Date of Birth		Marital Status
Gender		SMS Service
Nationality		Prefered Language
Email address		Profile Img.
Particulars of Spouse (If Married)	Name NRIC No Date Of Birth	Particulars of Beneficiary	Name NRIC No Date Of Birth
Others Information	1. Have you and/or your spouse ever been convicted of any violation of criminal law before? Yes No 2. Have you ever been bankrupt before? Yes No 3. Name one (1) person (non-relatives) whom you know that the Company may refer to for references Referee Name Occupation Telephone Address	Terms and Condition	Code of Ethics Click to read the Code of Ethics I have read and willing to comply with the Code of Ethics dilligently and at all times Additional Notes Click to read the Additional Notes I have read and understand the additional notes Declaration Click to read the Declaration I have read and understand the cotent of the Declaration

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