E-Wallet Application Form

Requirement and instructions Please write in capital letters. Tick or delete where applicable.

A. Partner Details
Name (as per IC/MyKad) Mr. Mrs. Mdm. Others (e.g. Dr. / Dato, etc.) Non-Malaysian

Partner Tier

Agency

Neighbourhood Centre

Premier Shop

Sales Agent

Company Name

Sales ID Code

REDtone Mobile No. to be set as E-Wallet Account

E-Wallet Type

Master E-Wallet

Sub E-Wallet Neighbourhood Centre > RM 500 Sales Agent > RM 100

Starter Pack Amount [RM]

Agency > RM 1,000 Premier Shop > RM 1,000

B. Partner Declaration
I declare that all the above information is true and complete.

Applicant's Signature Date d d m m y y y y

C. Parent Agency Details

Agency Name Channel Manager [Name] Agency ID D. For REDtone Office Use Documentation Checklist 1 Partner Application Forms 2 Proof Payment Bank-in slip [ Cash deposit slip or Cheque deposit slip ] Bank in to RHB Bank : REDtone Mobile SDN BHD Account No. : 26212 000005590 Cheque Date d d m m y y y y Cash Regional

Processed By:

Initial & Stamp: _____________________________

REDtone Mobile Sdn Bhd (619094-D). Suites 29-30, 3Ath Floor, IOI Business Park, 47100 Puchong, Selangor, Malaysia. Customer Care: 1800 11 0800 www.redONE.com