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•%!%• MyDoclab
Vendor Registration Form
Parties to the Agreement
MyDoclab Sdn Bhd Vendor

Business Name MyDocLab l)rt,1 •OC/1'{ V

Legal entity : MyDocLab Sdn Bhd Ott1 10til< C'O-' f!.IIP

Website
www.mydoclab.com r,, ww · oli0-,Jet1J •Com - '"J
L2-7D Plot 105 Sungai ' - /, dl/<AtJ "'V f / / {j. I

Address Keluang 5 Zon Perdagangan l!.ttj i,t_it\ ¤1l)INt1> ut,7«.

Bebas Fasa 4 L2 Penang
'tr ~>o, •~Gl)l'lt; Pc--'JA-jJl ,'
SME Bayan Lepas 11 900
t[l, l't "'(o ~e,.
Pulau Pinang
Company Registration Number 140233 1-U I >,J~.l'f - lf ·
Represented by Danniel Tan :2,.~lj/ll<...I 1/, H,I 2--ft1:-'r ,._,11,

Position lO - t o u rv Oc~ Cl- C-oC>

Vice Pres ident
Contact Email admin@mydoclab. com

Invoicing Contact

Name* : 2,Uljl)[<-1 g IN ;wj-l<A~l/r

Position *: Cc>- filul\lDITT2, COO

Email *: ,2.uhi;:~. @ dr'.ef't.dta.1- ca"' ....)

Phone * : 013_ fil'1'f11U
Doctor Registration No* :

Vendor Bank Account Details

Bank Name: lt1il,Y(:,'7Nk. li'U\rll\c.

Account Name: 01ET •DCIH .rQr-J · &11D,

AccountNo: ;;bd'f~14d-14lb
Swift: m&e,£ IY!il:-L-

The above conditions , and attached terms and conditions, are agreed to by the parties
hereunder:

SIGNED BY, for and behalf of:

MyDoclab Sdn Bhd

Vecdoc

Date: 2.o / lo /°1A, l.. 3 Date: ,).o/10/:l.~J

Name: N v r .f't..o. 1-; to-'- Name: 2-tl-111J1LJ '&IIJ '2..~t-~.._,,i
Position 1-ivh-; +; 0 ,-'1./ fo,[U t1<:ec.~h\,e P o sition Co - f"oU.:l()f.(. ..@- l ~•·