New Membership (RM100) Renewal Membership (RM15) Lifetime Membership (RM150) KELAB PEMINAT HONDA STREAM MALAYSIA (4927-11-WKL)

Regular Member Lifetime Member

I would like to apply for the Membership. (Please tick the appropriate box):

A. PERSONAL PARTICULAR ( Kindly complete all section for New & Lifetime Membership) Name (as per NRIC / Passport) NRIC / Passport No. MyS Forum Nickname Date of Birth Place of Birth Citizenship Religion Gender Marital Status Mobile Residence Office Email (FB) Job Post Correspondence Address Male Single Female Married

Postcode Shirt Size M

Town L XL XXL

State & Country (T-Shirt not applicable for Renewal Membership) C. PAYMENT INSTRUCTION Cash Payment Bank draft / cheque no. _____________ for RM _____________ made payable to CKD CBU Auto Manual "Kelab Peminat Honda Stream Malaysia" Electronic Banking Transaction 5621 0662 3120 Maybank
Date:

B. VEHICLE DETAILS (New & Lifetime Membership fill completely) Vehicle Registration No. Car Maker Model Code Model (RN) Year Manufacture Engine Capacity Body Color Expiry Insurance D. DECLARATION
I, hereby declare that all the information given above and in the annexures (if any) in the Application for Membership is true and correct and that I have not been expelled or been refused admission by any Clubs; been convicted of any criminal offence or imprisonment in Malaysia or elsewhere; I am NOT a bankrupt. I hereby authorize the Kelab Peminat Honda Stream Malaysia to obtain information from other Clubs of which I am a member, wherever necessary. I hereby fully declare that I agree to be bound by the Constitutinal Rules and ByeLaws of the Club if I am admitted as a member. I fully realize that omission or falsification of information will be considered sufficient reasons for rejection of this application or for dismissal.

E. ADMINISTRATION (For Management Use Only) Received by & date Approved by & date Cash Bank Draft Online Payment Membership No Effective Date No of Loyal Member ID Forum ID MyS

Signature:-

Date:Introducer ID (if any) :-

Disclaimer
Submission of the application form and payment of membership fees is not proof of acceptance of verification. MyS has the right to reject any application without disclosing the reasons therewith. Applicant will be duly notified by MyS of the status of their application through email/phone within 1-2 weeks of application & payment and duly return the verified fee should your application be rejected

KELAB PEMINAT HONDA STREAM MALAYSIA (4927-11-WKL) No.2C, Jalan Pahang Barat, Off Jalan Pahang, 53000 Kuala Lumpur, Wilayah Persekutuan. membership@mystreamclub.com / Fax no. :- +603 4021 9227