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:

Sponsors name: Sponsors name:

Sponsors ID: Sponsors ID:

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

Place your original IC/PR card here (front side only) Place your original IC/PR card here (front side only)

I hereby consent and certify that the information given above is true and correct to the best of my 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. By signing below, I 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. 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