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Premium Items Order Form

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PruBSN Premium Items Order Form

No Premium Items Price (RM) Quantity Total (RM)


1 Certificate Folder RM1.00
2 Paper Bag (10 pcs/pack) RM18.00
3 Ball Pen (Blue/Red) RM1.50
4 Coin Bank RM11.00
5 Balloon (30 pcs)(Red/Blue/Silver) RM15.00
6 Name Card Holder RM14.00
7 Yassin & Tahlil RM8.00
8 Sticky Note RM5.00
9 Stainless Steel Thermo Bottle RM12.00
10 Note Book RM6.00
11 Exclusive PruBSN Silk Tie Big (9cm) RM40.00
12 Exclusive PruBSN Silk Tie Small (6cm) RM40.00
13 Exclusive PruBSN Shawl RM45.00
14 Thumb Drive (4GB) RM20.00
15 Corporate Folder RM40.00
16 Ummah Box RM50.00
17 Sejadah with Gift Box RM80.00
18 iPad 2 Case RM66.00
19 Galaxy Tab 7 Plus Case RM64.00
20 No.1 T-Shirt


*Female size only
Size Qty
S
M
L
Size Qty
XL
2XL
RM35.00

21
Smartlink Shirt


*Order from HQ only
Size Qty
M
L
Size Qty
XL
2XL
RM17.00

GRAND TOTAL
I hereby authorized the company to deduct the above amount from my commission account



Name :__________________________________ Agency Code :_______________________

Branch/Region :_______________ Date :__________ Tel :______________ Signature :_______________

In the event that the amount is unrecoverable from the agent such as termination and for whatsoever reason, the total outstanding
amount will be debited from Quality Leaders account immediately



Name :__________________________________ Agency Code :______________________

Branch/Region :_______________ Date :__________ Tel :______________ Signature :_______________


Note :
1. Payment will be paid via commission deduction
2. Incomplete forms will not be entertained
2. Order form must be duly signed and authorized by your direct Quality Leader
3. Fax order form to Spektrum Cerah
Fax : 03-8943 6580 (Attn : May)
Tel : 03-8943 3580
Email : prubsn.req@gmail.com
4. Please contact Business Development Department at 03-2037 0248 or email to prubsn.biz.dev.dept@prubsn.com.my for any assistance
Please tick () in the box :
PBTB
PAMB
QUALITY AGENT
QUALITY LEADER
FOR OFFICE USE
Date :
Remarks :

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