Wellness Application Form

Authorized Personnel Name
NRIC
Email
Tel No.
Social
WeChatLineWhatsApp
Business Registration Name & Address (Wherever Applicable)
Postcode
State
Tel No.
Fax No.
Business Registration No. (Please attached copy of Borang E and SSM Maklumat Perniagaan/ Form 49, 24 and 9)
Borang E
Borang SSM
Priciple Activities
Total no. Employees
Nature of Business
Type of Company (Please tick where applicable)
Public Limited

Private Limited

Sole Proprietor

Partnership

Others (please specify)

Director(s) / Partner(s)

Established since
Annual Turnover