1) Salution Mr. Mrs. Miss 2) Full Name* 3) Company Name 4) Phone Number * Example : 91 40 24012345 (Country & area code should not start with Zero) 5) Mobile Number* * Example : 91 9441234567 (Country & area code should not start with Zero) 6) Address 7) Email* 8) Pin

9) Line of Business Beauty & Health Care Books & Magazines Clothing & Accessories Economic Hotels Education Entertainment Fitness & Sports Footwear & Shoes Gifts & Flowers Home Appliances Home Furnishing Luxury Hotels Music & Movies Online Portals Optic & Jewellery Pharmacy Real Estate Restaurants Bar, Pubs & Night Club Retails Stores Tattoos Tours & Travels Others

10) Line of Business (Others) 11) No. of Outlets (Retail Stores) Terms and Coditions* I/We hereby confirm that the above information is true and agree to be borne by terms and conditions set by R&A Dynamic Resources (M) Sdn Bhd governing the use of MY HANDY PRIVILEGE membership card. Saya/Kami mengaku bahawa segala keterangan yang diberi adalah benar and patuh kepada segala terma and syarat daripada R&A Dynamic Resources (M) Sdn Bhd dalam pengunaan kad membership MY HANDY PRIVILEGE card.