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  • Archthird (3rd) Parties Form (202303 Version)

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    sitizuhaida87
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    Original Title

    _archthird (3rd) Parties Form (202303 Version)(1)

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    3 views1 page

    Archthird (3rd) Parties Form (202303 Version)

    Uploaded by

    sitizuhaida87

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 1

    THIRD (3rd) PARTIES FORM

    Details *Please Tick (X) On The ☐

    Application ☐ Monthly Payment ☐ Fund Transfer ☐ New Sales 1st Payment

    Type ☐ Outright ☐ Instalment ☐ Rental ☐ Service Membership ☐ Advance A/S (Booster Pump)

    To whom it may concern,


    NOR HAFSAH BT ROSLAN
    Kindly be informed that I/We _______________________________________________________________________________________
    860927565948
    NRIC No. / Company No. ___________________________________________________agree to be responsible for:

    Order No 4560344
    Product Name STORM
    Product Model AP-1516D
    Registered Under The Name
    Outright/Instalment ☐ Cash RM ☐ Cheque RM ☐ Credit Card RM
    ☐ Cash RM ☐ Cheque RM ☐ Credit Card RM

    Rental ☐ RPF RM ☐ Adv 1 Month RM ☐ Adv ½ Years RM


    ☐ Auto Debit RM ☐ Direct Debit RM

    Issuing Bank CIMB BANK


    Account No
    Credit Card No
    5196032183029871
    [COMPULSORY) Attached Herewith 3rd Party Payer's
    Owner Signature (As in Sales Order Form) Company Stamp (If any)
    Supporting Document Of:

    Individual (Bank Account)


    1 -NRIC Copy & ☐
    -Bank Statement I Transaction Slip

    Name : PARIDAH BINTI AWANG LAH


    Date :
    4/05/2024
    3rd Party Payer/New Owner Signature Company Stamp (If any)

    Individual (Credit Card)


    2 -NRIC Copy ☐
    -Credit Card Copy (Front & Back)

    Name : NOR HAFSAH BT ROSLAN


    Date :04/05/2024
    Company
    Contact No : 012-279 1474
    3 -SSM/Company Form ☐
    Relationship : daughter
    (For Company As 3rd Party)
    3rd Party E-mail :

    I have read, fully understand and accept the term and conditions of the 3rd party payment. I will bear any responsibility should the 3rd Party Payer fail to
    settle the payment. The above shall be implemented with immediate effect.

    Coway (Malaysia) Sdn. Bhd. (735420-H) (AJL931694) Page 1 of 1 F/S&P/V2023


    PRIVATE & CONFIDENTIAL

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