Member Registration Form

Referrer Information

Sponsor ID *

Name : ADMIN

Mobile No : 123123123

Personal Information

Username

Full Name(As per IC or Passport) *

Email *

Gender

Nationality *

IC No. / Passport / Others *

Race

Date Of Birth *

Mobile No *

Currency *

Withholding Tax *

Registration Date *

Spouse Details

Spouse Name

Spouse Identity Card / Passport Number

Address Information

Address 1 *

Address 2

Address 3

Postcode *

Country *

State *

Area *

Shipping Address Information

Shipping Method * Self Pick UpDelivery

Choose Business Center

Business Center ID *

Ranking

Ranking	BV
M	0 BV
M1	1500 BV
M2	5000 BV
M3	8000 BV

Cart List

Note: Quantity only allowed positive number.

Registration Fee : 0.00

Total Price :

Total BV :

Personal Information

Sponsor ID :
Ranking :
Full Name :
Mobile No :
IC No. / Passport / Others :
Email :
Address :

Product and Payment

Shipping Method :
Shipping Address :
Business Center :	* Please be reminded to do Self Pickup only at the Business Center you have selected above.
Shipping Fees
SubTotal	0.00
Registration Fee	0.00
Product :
Total Product Price :
Total Product BV :
GST :
Net Amount :

Payment Method :

Payment Method

Online Payment/ATM Cash Deposit

Beneficiary name :
Nutruo Sdn Bhd
( formerly known as Cosmic Health Restore Sdn Bhd)

Bank name : CIMB Bank

Account No : 8600260737

SubTotal	0.00
Shipping Fees	0.00
Registration Fee	30.00
Total Amount	0.00	Total BV	0.00

Terms & Condition Link

Business Center ID	Name	Address	Country	Business Center Type
MYBC010523	Bangi Centre	NO 1 JALAN 6C/5 SEKSYEN 16,,,	Malaysia	Branch
MYBC010524	Pelangi Center (Johor)	IC HEALTH SDN BHD, NO.52, JALAN KUNING,,TAMAN PELANGI,,	Malaysia	Branch
MYBC010525	Sg Buloh Centre	NO. 203A, JALAN WELFARE,,KAMPUNG BARU,,	Malaysia	Branch
MYBC010526	SEREMBAN 2 CENTRE	75, JALAN S2 F2, GARDEN HOMES, ,SEREMBAN 2, ,	Malaysia
MYM406713	HQ BUSINESS CENTRE	B-7-1,BLOCK B, ATIVO PLAZA,NO. 1 JLN PJU 9/1, ,DAMANSARA AVENUE,BDR SRI DAMANSARA	Malaysia

Referrer Information

Personal Information

Spouse Details

Address Information

Shipping Address Information

Choose Business Center

Ranking

Cart List

Personal Information

Product and Payment

Payment Method

T/T Bank