Cili bangi licensing agreement agent

Page 1

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


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