1|Page Non Exclusive Licensing Agreement To Sell and Distribute Cilibangi Seeds and Home Growers Product
Cilibangi Agent (Sub-Licensee) Agreement PLEASE COMPLETE ALL DETAILS AND SIGN ACCORDINGLY (PLEASE USE BALL PEN AND WRITE IN BLOCK LETTERS) NAMA K.P. (Sila Lampirkan Satu Salinan KP) / NAME AS PER NRIC (Please Attach A Copy of NRIC)
No K.P. BARU / NEW NRIC NO.
TARIKH LAHIR / DATE OF BIRTH
JANTINA / SEX Lelaki / Male
BANGSA / RACE Perempuan / Female
PERKERJAAN / OCCUPATION
______________________________
ALAMAT EMAIL / EMAIL ADDRESS
____________________________
NO TELEFON / TELEPHONE NO Pejabat / Office :
_____________________________
Rumah / House _____________________________
Telefon Bimbit / Handphone: _______________________________ NAMA SUAMI ATAU ISTERI / SPOUSE NAME
UNTUK DEPOSIT KOMISEN / FOR DIRECT DEPOSIT OF COMISSION BANK / BANK CAWANGAN / BRANCH
____________________________________
___________________________________
BANK A/C NO.
ALAMAT SURAT MENYURAT / MAILING ADDRESS
BANDAR
POSKOD
NEGERI / STATE
ALAMAT PENGHANTARAN / SHIPPING ADDRESS (Kecuali alamat peti surat / P.O. Box Address is not valid)
BANDAR NEGERI / STATE
FACEBOOK ACCOUNT NAME:
POSKOD