Ref No: _______________

PRE - RETURN FORM

Distributor name: Contact No:
Distributor ID:

Total Refund:

Please list down all the products to be return:

Descriptions Sales Order
No Product Code Units
(To indicate * if return partial of package) No

Please fax in the Pre-Return Form, Sales Invoices and Authorization Letter at 1800-88-2199 (KL) / 604-657 77 11 (PG) / 607-334 07 11 (JB) and please
call to fix an appointment. For further assistance, please call Refund Counter at 1800-88-2099 (KL) /604- 656 7700 (PG) / 607-334 07 00 (JB)

By signing this Pre-Return Form (“Form”), I agree and give my consent that Nu Skin (Malaysia) Sdn. Bhd. (“NSMY”) may collect, use,
process and disclose my personal data given in this Form for the purpose of administration in relation to the matters referred to
herein. I confirm that I have read and fully understand the provisions regarding the collection, use, processing and disclosure of
personal data set out in NSMY’s Personal Data Protection Notice and Section 2 of Chapter 1 of NSMY’s Policies and Procedures and I
agree to abide by them

Distributor’s Signature Date

For Internal use only.

Verified by : Approved by :
Name : Name :

Date : Date :

Appointment Date:

Remarks: