Atomy Membership Application (Ms 01 02) 1
Atomy Membership Application (Ms 01 02) 1
Atomy Membership Application (Ms 01 02) 1
Name: Name:
Member ID: IC/PR card No.: Member ID: IC/PR card No.:
Place your original IC/PR card here Place your original IC/PR card here
I hereby consent and certify that the information given above is true and correct to the I hereby consent and certify that the information given above is true and correct to the
best of my knowledge. I understand that a false statement may disqualify me for benefits. best of my knowledge. I understand that a false statement may disqualify me for benefits.
By signing below, I agree to register as a member of Atomy Malaysia Sdn. Bhd. By signing below, I agree to register as a member of Atomy Malaysia Sdn. Bhd.
Atomy Malaysia Sdn. Bhd. (1119724-A), Suite 18.1, Level 18 of Wisma Nusantara, Jalan Puncak Off Atomy Malaysia Sdn. Bhd. (1119724-A), Suite 18.1, Level 18 of Wisma Nusantara, Jalan Puncak Off
Jalan P. Ramlee, 50250 Kuala Lumpur, Malaysia. Jalan P. Ramlee, 50250 Kuala Lumpur, Malaysia.
Tel: +603 2718 8999 Fax: +603 2718 8988 website: www.atomy.com/my Tel: +603 2718 8999 Fax: +603 2718 8988 website: www.atomy.com/my