ATOMY MEMBERSHIP STATUS CHANGE APPLICATION ATOMY MEMBERSHIP STATUS CHANGE APPLICATION

(MS-03-04) (MS-03-04)
Change to consumer distributor Change to consumer distributor
Member Name: Member Name:

Member ID: IC/PR card No.: Member ID: IC/PR card No.:

Sponsor Name: Sponsor Name:

Sponsor ID: Sponsor ID:

*Consumer is allowed to convert to distributor only once a year. The one-year period starts *Consumer is allowed to convert to distributor only once a year. The one-year period starts
from last date of changes made. from last date of changes made.
Please place original IC/PR card (front side only) on the column provided, take a picture of Please place original IC/PR card (front side only) on the column provided, take a picture of
this form and upload the file through www.atomy.kr/m/mload_my this form and upload the file through www.atomy.kr/m/mload_my

Place your original IC/PR card here (front side only) Place your original IC/PR card here (front side only)

I hereby consent and certify that the information given above is true and correct to the best of my I hereby consent and certify that the information given above is true and correct to the best of my
knowledge. I understand that a false statement may disqualify me for benefits. By signing below, I knowledge. I understand that a false statement may disqualify me for benefits. By signing below, I
agree to register as a member of Atomy Malaysia Sdn. Bhd. agree to register as a member of Atomy Malaysia Sdn. Bhd.

Signature: Date: Signature: Date:

Atomy Malaysia Sdn. Bhd. Company No.201401043544 (1119724-A) Atomy Malaysia Sdn. Bhd. Company No.201401043544 (1119724-A)
18th Floor, Menara UMW, Jalan Puncak Off Jalan P. Ramlee, 50250 Kuala Lumpur, Malaysia. 18th Floor, Menara UMW, Jalan Puncak Off Jalan P. Ramlee, 50250 Kuala Lumpur, Malaysia.
Tel: +603 2718 8999 Fax: +603 2718 8988 website: www.atomy.com/my Tel: +603 2718 8999 Fax: +603 2718 8988 website: www.atomy.com/my