MEMBER APPLICATION FORM

* Disclaimer: You confirm that you are 18 years of age or over upon time of registration. Please complete all necessary fields below and ensure you sign and date this form.

APPLICANT PERSONAL INFORMATION

Name:

NRIC: Gender: Male Female

Mailing Address:

Postcode: City: State:

Tel: (Mobile) (Home) (Office) Email:

REFERRAL (to be filled by the referral AJ authorized agency)

Affiliate Name: Affiliate ID: Contact No:

AFFILIATE JUNCTION (AJ) PRIVACY POLICY

1. Your privacy is important to you and to us. So we’ll protect the information you share with us. This privacy policy explains the procedures for data collection and
use in Affiliate Junction program and website. When you sign up as an AJ member of affiliate, you accept the procedures for data collection and use described
below.

2. We won’t sell or give away your personal detail, mail address, phone number, email address or any other information to anyone.

3. AJ has taken strong measures to protect the security of your personal information and to ensure that your choices for its intended use are honored. We take strong
precautions to protect your data from loss, misuse, unauthorized access or disclosure, alteration or destruction.

4. Your personal details are collected for program identification purpose in order for you to enjoy retail privileges, rebate and redemption points at participating
merchants’ outlets.

5. AJ and its merchants may contact your from time of time for program promotions and marketing purposes.

6. You will asked to produce your MyKad at merchants’ outlets for verification purpose in order for merchant to extend retail privilege and rebate to you.

7. Your personal information is never shares outside the company without your permission, except under conditions explained above. Your information may be
stored and processed in Malaysia or any other country where AJ, its subsidiaries, affiliate or agent are located.

8. AJ will disclose your information, without notice, only if required to do so by law or in the good faith belief that such action is necessary to: (a) conform to the
addicts of the law or comply with legal process served on AJ or the site; (b) protect and defend the right or property of AJ and its family of Websites, and, (c) act in
urgent circumstances to protect the personal safety of users of AJ, its Websites, or the public.

9. If for some reason you believe AJ or any of its Affiliate has not adhered to these principles, please notify us by email at privacy@aj.com.my and we will do our best
to determine and correct the problem promptly. Be certain the words Privacy Policy are in the subject line.

I consent to give my personal details requested above to AJ and/or its authorized affiliate in order to process my
registration as an AJ Member.

I have read the Privacy Policy and agree to abide all terms set forth in these documents

Signature
Name: Date:

I Synergy Universal Holding Sdn Bhd (868377-U)

Head Quater
Unit B-10-1, Northpoint Offices, Mid Valley City, No. 1, Medan Syed Putra Utara, 59200 Kuala Lumpur.
Operation Office
No. 1-1, Jalan Tasik Utama 4, Medan Niaga Tasik Damai, Sungai Besi, 57100 Kuala Lumpur.
Tel: +603-9054 8355 Fax: +603-9054 9355 Website: www.aj.my

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