New Enrollment Application Form (ENG)

SHAKLEE DISTRIBUTOR APPLICATION
PLEASE USE BLOCK LETTERS
SHAKLEE ID NO:
Your application is valid only upon purchase of a ‘Shaklee Opportunity Kit’
APPLICANT INFORMATION
APPLICANT’S NAME
SPOUSE’S NAME
PREFERRED NAME
INCOME TAX NO.
I.C. NO. (NEW)
I.C. NO. (OLD)
DATE OF BIRTH
GENDER
D M
M
Y
GENDER
FEMALE
Y
D
RACE
MALAY
I.C. NO. (OLD)
DATE OF BIRTH
MALE
D
I.C. NO. (NEW)
D M
M
Y
MALE
FEMALE
INDIAN
OTHER
Y
RACE
CHINESE
INDIAN
OTHER
MALAY
CHINESE
MAILING ADDRESS
POSTCODE
TOWN
HOME
HANDPHONE
STATE
OFFICE
FAX
SIGN UP FOR ELECTRONIC FUNDS TRANSFER (EFT) FOR BONUS PAYOUT
BANK NAME:
ACCOUNT
BRANCH
SAVINGS
CURRENT
EMAIL
ACCOUNT NO.
LANGUAGE PREFERRED
English / Bahasa Malaysia
(EXACTLY AS IT APPEARS ON YOUR SAVINGS ACCOUNT PASSBOOK/BANK STATEMENT)
English / Chinese
I/We agree to abide by the terms set forth in the Business Manual and the statement of Privileges & Responsibilities (P&R), as amended from time to time, and other Shaklee
publications, including any subsequent changes thereto about which Shaklee Independent Distributors are notified
I/We have read and agree to all terms and conditions stated above and certify that all the information provided is correct.
I/We Agree, I am declaring that I have read and understood, and agreed to be subjected to the Shaklee Products (Malaysia) Sdn. Bhd. (hereinafter referred to as “Shaklee”) Privacy Notice.
APPLICANT’S SIGNATURE
DATE
SPOUSE’S SIGNATURE (IF JOINING)
DATE
SPONSOR INFORMATION
NAME
SHAKLEE ID
HOME
OFFICE
HANDPHONE
SHAKLEE PRODUCTS (MALAYSIA) SDN BHD (AJL93747) Company No 301287 - T
SPONSOR’S SIGNATURE
DATE
Home Office : Level 9, The Pinnacle, Persiaran Lagoon, Bandar Sunway, 47500 Subang Jaya, Selangor. Tel: 03-5622 3188 Fax: 03-5622 3199
Penang Branch : No 81, 83 & 85, Jalan Todak 6, Pusat Komersial Sunway Perdana, 13700 Seberang Jaya, Penang. Tel: 04-383 8261 Fax: 04-383 8560
lpoh Branch : 32, Medan lstana 1, Bandar Ipoh Raya, 30000 Ipoh, Perak. Tel: 05-241 8260 Fax: 05-241 8263
Johor Bahru Branch : 14, Jalan Molek 1/10, Taman Molek, 81100 Johor Bahru, Johor. Tel: 07-352 5188 Fax: 07-352 4188
Kuala Lumpur Branch : 32, Jalan Rampai Maju 3, Taman Sri Rampai, 53300 Kuala Lumpur. Tel: 03-4142 1067 Fax: 03-4142 1027
Kota Bharu Branch : 319, Section 25, Jalan Sultan Yahya Petra, 15200 Kota Bharu, Kelantan. Tel: 09-747 8688 Fax: 09-747 7711
Kota Kinabalu Branch : Lot 4.1. Neutron Point, Lorong Poin Neutron, Jalan Lintas Khidmat, 88300 Kota Kinabalu, Sabah. Tel: 088-393848 Fax: 088-393851
Email : [email protected]
Website : http://www.shaklee.com.my
DISTRIBUTORSHIP REQUIREMENTS - You must be at least 18 years of age and be a Malaysian citizen or Permanent Resident.
Members may sign up individually or jointly with their spouse. Spouses may not have separate Distributorship.
ID NUMBER - Your Shaklee ID No. is as printed on this application form. It should be used for all communications with Shaklee Products
(Malaysia) Sdn Bhd, including sponsorship.
DISTRIBUTING AND SELLING PRODUCTS - Approved applicants may call themselves Distributors and are authorized to sell Shaklee
products to others. Because Shaklee is a network marketing company, Distributors may not sell Shaklee products directly or indirectly to
or from retail stores.
UNAUTHORIZED CLAIMS AND PRACTICES - Distributors may not make unauthorized claims about Shaklee products or Sales Plan
that are contrary to literature and labels published by Shaklee Malaysia. Shaklee Malaysia may terminate your Distributorship
immediately if you make unauthorized claims or practices, discredit the Shaklee name, violate the requirements of Shaklee Sales Plan,
Business Manual, or the Statement of Privileges and Responsibilities (P&R), or for any other cause.
INDEPENDENT CONTRACTOR STATUS - Distributors are Independent Contractors. Distributors are not employees, legal
representatives, or agents of Shaklee, or of any other Independent Shaklee Distributorship. Distributors, therefore, are not treated as
employees for purposed of income tax withholding, labor laws, or any other laws covering employees.
AGREEMENT - Shaklee Sales Plan, Business Manual, P&R and other Shaklee publications shall constitute a part of this agreement.
I/We acknowledge receipt of copies of Shaklee Business Manual and other Shaklee publications which are herby incorporated by
reference and agree to abide by all the terms and conditions in these publications.
ANNUAL RENEWAL - If the Distributor does not perform any sales transaction in a year, the Distributor is assumed to have resigned and
the Distributor will be automatically terminated unless the Distributor notifies Shaklee in writing that he/she wishes to remain active.
GOVERNING LAW - The Distributorship will be governed by the laws of Malaysia. I/We undertake to comply all laws, rules, and
regulations of Malaysia relevant to my/our Distributorship including the provisions of the Direct Sales Act, 1993, described in the Business
Manual, and will indemnify Shaklee Products (Malaysia) Son Bad against any violation of this agreement by me/us, however, arising.
PERSONAL DATA PROTECTION ACT (PDPA) 2010 - I/We expressly consenting to and authorizing Shaklee and any External Parties to
collect, hold, use, delete, disclose, transfer, administer and process in any other way, all my personal data (including sensitive personal
data and personal data of other party provided by me) (hereinafter referred to as “Personal Data”) given now or that is subsequently
obtained from time to time for the purposes below. I understand that if I do not provide the Personal Data requested, Shaklee will not be
able to carry out the purposes below:
(1) To process this application and all other purposes which are required in relation to any products and services offered by Shaklee
(2) To respond to your enquires and to resolve disputes
(3) To support Shaklee in respect of internal functions such as evaluating the effectiveness of marketing, market research, audit and
to prevent fraud from time to time
(4) For any purpose required by law or regulations