BORANG PERMOHONAN

APPLICATION FORM
Maklumat Penaja Introducer Information
ID Pilihan Penaja
Introducer Username

No. Tel Bimbit

No. KP Penaja
NRIC No.

Mobile Tel No.

Maklumat Peribadi Personal Information

ID Pilihan
Username

Nama
Name

No. KP(Baru)
New NRIC No.

No. KP (Lama)
Old NRIC No.

Waris

Next of Kin

Hubungan
Relation

No. KP(Baru) Waris

Kin New NRIC No.

No. Tel Waris

Kin Tel No.

Emel
Email

Maklumat Kenderaan Vehicle Details

Nama Pemilik

Vehicle Owner

No. KP(Baru)
New NRIC No.

No. KP (Lama)
Old NRIC No.

Tarikh Lahir

No. Daftar Niaga

(hari day)

Date of Birth

Business Register No.

(bulan month)

(tahun year)

Alamat
Address

Poskod
Postcode

No. Tel Bimbit

Mobile Phone No.

No. Tel Rumah

Home Tel No.

No. Siri Geran

No. Pendaftaran Kenderaan

Veh. Registration No.

Veh. Certificate. No.

No. Enjin

Veh. Engine No.

No. Chasis

Veh. Chassis No.

Buatan/Jenama
Make / Model

Kapasiti Enjin

Tahun Pembuatan

Engine Capacity

Year of Manufacture

Maklumat Insurans Terdahulu Previous Insurance Details

NCB

20%

15%

NCB

Tarikh Tamat Insurans

Insurance Expired Date

(hari day)

(bulan month)

(tahun year)

Syarikat Insurans
Insurance Company

No. Polisi
Policy No.

Cermin

Pemandu Kedua

Tambahan
Additional

Wind Screen

2nd Driver

Jumlah Cukai Jalan (RM)

Roadtax Amount

iShare Starter Kit (iKit) Only RM100

Tandatangan Signature

Tandatangan Pemohon
Applicant Signature

* Dengan menandatangani borang ini, anda mengakui bahawa anda bersetuju

dengan terma dan syarat-syarat iShare / By signing this form, you are
acknowledging that you have agreed with iShare terms and conditions.

Tarikh
Date

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - iShare

We Share . We Help . We Care

Thank You Very Much for Your Priceless Support. We Can Make a Difference

Congratulations !!

VEHICLE NO :

You have successfully registered as a member of iShare Community.

Please follow the terms and conditions of iShare Programme.

Terms & Conditions :

1. Applicant must be aged 18 years and above.
2. Each application form is only for one vehicle.
3. All form which are not complete within two
weeks will be returned to the applicant.
4. If anyone found this card, please kindly return
to iShare company.

Checklist :
Please register your TnG card at www.touchngo.
com.my
Make sure you receive a SMS from iShare system
that proves you have officially registered.
Thank you very much for your priceless support.
We can make a difference.

GLOBAL GROUP HOLDINGS SDN. BHD (829121-H)

HQ : No. 38-1, Jalan 7/7B, Seksyen 7,
43650 Bandar Baru Bangi, Selangor Darul Ehsan
Tel

: +603 8922 2277 | Faks : +603 8927 5229

/ishare.com.my
Web : www.ishare.com.my

Contact iShare