ATOMY MEMBERSHIP APPLICATION (MS-01-02) ATOMY MEMBERSHIP APPLICATION (MS-01-02)

Name: Name:

Member ID: IC/PR card No.: Member ID: IC/PR card No.:

Contact No. Email: Contact No. Email:

Sponsor’s Name: Sponsor’s Name:

Sponsor’s ID: Sponsor’s ID:

Please place your original IC/PR card on the column provided, take a picture of this form and upload Please place your original IC/PR card on the column provided, take a picture of this form and upload
the file through www.atomy.kr/m/mload_my. the file through www.atomy.kr/m/mload_my.

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.

Signature:_______________________ Date:_________________________ Signature:_______________________ Date:_________________________

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