BIOCAREER INTERNATIONAL SDN.

BHD
Block A, No. 7-1-2 Megan Salak Park, Jalan 2/125E
Taman Desa Petaling, 57100 Kuala Lumpur.
Tel. No. : 03-90581918 Fax No.: 0390591918
Website: www.biocareer2u.com
PERSONAL DETAIL

USERNAME(ID):
FULL NAME AS NRIC:
NRIC NO:
ADDRESS:

TEL.NO: FAX NO:

DISTRICT:
E-MAIL ADDRESS: *(For eDistrict Application)

PACKAGE DETAIL
PACKAGE W.M’SIA(RM) E.M’SIA(RM) GLOBAL(WM) GLOBAL(EM) TICK REMARK
1. VICE PRESIDENT RM250.00 RM260.00 USD 75.00 USD78.00
2. PRESIDENT RM1000.00 RM1050.00 USD300.00 USD315.00
3. eMOBILE RM1130.00 RM1190.00 USD340.00 USD357.00
4. eDISTRICT RM5000.00 RM5250.00 USD1500.00 USD1575.00

BANK DETAILS

BANK: BRANCH:
ACCOUNT NO.: ACCOUNT TYPE:

INTRODUCER DETAILS

INTRODUCER NAME & USERNAME:

PLACEMENT NAME & USERNAME:

NOMINEE DETAILS

NAME:
NRIC NO: TEL NO.:
RELATIONSHIP:

I hereby agreed and accepted all the terms and conditions of Biocareer International Sdn. Bhd.

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Signature Date

FOR OFFICE USE

MODE OF PAYMENT:
PRODUCT DELIVERY: VERIFIED BY: