CUSTOMER HEALTH DECLARATION

SA AMURTHA VALLI ENTERPRISE

DATE :

NO TIME AM/PM CUSTOMER NAME CONTACT NUMBER TEMPERATURE

10

11

12

13

14

15

16

17

18

19

20

Procedure:
1. This procedure to be done every day until futher notice.

2. This a summary of Customer Health Declaration afetr customer fill up the Customer Declaration Form.

3. This summary to be stapled together with all frorms that have been filled up each day.

4. The summary and form to be kept safety untill futher notice.

12-Jul-20 12-Jul-20 SHELL-PPK MANJONG PERAK MY RM60.13
12-Jul-20 11-Jul-20 PETRON GNG SMGL NORTH BAGAN SERAI MY RM59.37
7-Jul-20 7-Jul-20 SHELL-KOH MI HOLDING AYER TAWAR MY RM50.01
7-Jul-20 6-Jul-20 MAKNA DIRECT DEBIT-BA KUALA LUMPUR MY RM38.00
5-Jul-20 5-Jul-20 Shopee Malaysia KUALA LUMPUR MY RM180.26
4-Jul-20 4-Jul-20 U MOBILE T 33775840 KUALA LUMPUR MY RM94.45
2-Jul-20 2-Jul-20 BHPETROL-KAMPUNG CINA SITIAWAN MY RM68.15
29-Jun-20 28-Jun-20 Lazada KUALA LUMPUR MY RM31.28
29-Jun-20 28-Jun-20 Shopee Malaysia KUALA LUMPUR MY RM508.28
27-Jun-20 27-Jun-20 Shopee Malaysia KUALA LUMPUR MY RM29.89
27-Jun-20 26-Jun-20 SHELL-PPK MANJONG PERAK MY RM33.53
27-Jun-20 26-Jun-20 SILVER EAGLE PIONEER ENT SRI MANJUNG MY RM535.00
21-Jun-20 21-Jun-20 SHELL-PPK MANJONG PERAK MY RM55.70
19-Jun-20 18-Jun-20 Suruhanjaya Syarikat M MYH MY RM130.00
18-Jun-20 17-Jun-20 APPLE.COM/BILL ITUNES.COM IE RM3.90
13-Jun-20 12-Jun-20 SHELL-PPK MANJONG PERAK MY RM44.24
13-Jun-20 12-Jun-20 MAXIS-AUTO 2433267297 Kuala Lumpur MY RM209.90

RM717.38 1414.71
 9-Jul-20 CASH WITHDRAWAL RM150.00
8-Jul-20 CASH WITHDRAWAL RM1,500.00
8-Jul-20 CASH WITHDRAWAL RM1,500.00
8-Jul-20 CASH WITHDRAWAL RM1,500.00
8-Jul-20 MUNIAMAH A/P GOVINDA FUND TRANSFER RM1,010.00
7-Jul-20 MBB QR SILVER EAGLE PIONEE* 021570453Q RM90.00
6-Jul-20 TT S.A.AMURTHA VALLI E* TT RM1,300.00
6-Jul-20 TT S.A.AMURTHA VALLI E* TT RM3,000.00
-Jul-2020 MBB CT-TT JAYESEELAN AL MUNIA* TT RM500.00
1-Jul-20 TT S.A.AMURTHA VALLI E* TT RM2,200.00
1-Jul-20 MBB CT-TT JAYESEELAN AL MUNIA* TT RM1,500.00
1-Jul-20 TT CHEONG YU SING * TT RM800.00
30-Jun-20 INTEREST PAID
30-Jun-20 0184070699 UMOBILE * PREPAID RELOAD RM5.00
30-Jun-20 0164946155 DIGI * PREPAID RELOAD RM5.00
30-Jun-20 2006301001020007 T018241549820 * IPAY88 (M) SDN RM124.00

29-Jun-20 Tt AMIRUDDIN BIN SAKKA* TT RM20.00

28-Jun-20 INDAH WATER KONSORT* 35555333 RM50.00
28-Jun-20 INDAH WATER KONSORT* 50635101 RM50.00
28-Jun-20 MCIS INSURANCE BHD * 10590041 RM63.00
28-Jun-20 LEMBAGA AIR PERAK * 23724024MG0320 RM30.00
28-Jun-20 LEMBAGA AIR PERAK * 12294492MG0294 RM30.00
28-Jun-20 TENAGA NASIONAL BER* 220871598906 RM214.10
28-Jun-20 ASTRO * 0862800912 RM60.00
28-Jun-20 MAYBANK VISA CARD * XXXX-XXXX-XXXX RM516.58
28-Jun-20 MBB CT RUDRABHIRAMY ENTERP* Sambrani RM48.70
28-Jun-20 PRUDENTIAL ASSURANC* 34560514 RM171.00
28-Jun-20 PRUDENTIAL ASSURANC* 34555799 RM171.14
28-Jun-20 PRUDENTIAL ASSURANC* 34560623 RM181.82
25-Jun-20 CASH WITHDRAWAL RM500.00
25-Jun-20 MEPS FUND TRAN RM1,000.00
24-Jun-20 Aquarium Payment CHEONG YU SING * Aqua RM3,500.00
24-Jun-20 MBB CT JENSEN ONG CHUN SHE* Super Red RM650.00
24-Jun-20 CASH DEPOSIT RM500.00
24-Jun-20 CASH DEPOSIT RM1,500.00
24-Jun-20 MEPS FUND TRAN RM1,500.00
24-Jun-20 MEPS FUND TRAN RM1,500.00
16-Jun-20 MBB CT JAYESEELAN AL MUNIA* TT RM500.00
15-Jun-20 720601075725 KWSP - CTRL A/C 20200615120609 RM500.00

2-Jun-20 TT S.A.AMURTHA VALLI E* TT RM320.00

30-May-20 MAYBANK VISA CARD * XXXX-XXXX-XXXX RM579.45
30-May-20 AMERICAN EXPRESS CR* XXXX-XXXX-XXXX RM25.00

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