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Name of Company *

Company Registration Number

Registered Address*

Mailing Address

Office Number
Owner/Contact Person Name *
Mobile Number *
Email Address *
Website Address

Branch Address

Other Company’s Information
Type of Business
Mall Groceries24 Hour StorePharmacyElectronic/GadgetsFlower/GiftPet ShopCosmeticLocal ProductHobbyFashion
Service CleanMassageAutoBeautyHealthcareFood

Bank *

Bank Account Holder *

Bank Account Number *

Remarks
Attachment
Identity Card *
Front
Back
Drive License (For AUTO SERVICE Only)
Front
Back
Other License (If Any) – e.g: SSM/Towing License

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