Atomy member application form

PLEASE READ APPLICATION INFORMATION AND ATTACHED ALL INSTRUCTIONS CAREFULLY.
THIS AGREEMENT SHALL BE EFFECTIVE ONLY UPON ACCEPTANCE BY ATOMY (Singapore).

( Atomy allows only one member ID to each individual in international and one member ID for you and your spouse )

( This member ID will be activated once upon verification by Atomy (Singapore) )

EXPIRY DATE
expiry date (It should be remained more than 6 months and updated before expired or membership will be terminated)

APPLICANT’S NAME (as per NRIC or Passport)

LAST NAME	FIRST NAME
GENDER	FEMALE MALE
NRIC No/FIN No	DATE OF BIRTH
ADDRESS	POST CODE
E-MAIL
MOBILE	HOME PHONE

SPONSOR’S INFORMATION

I hereby consent and certify that the information given above is true and correct.

When completed, please email or fax a copy of this application to Atomy (Singapore).
It will takes about 2 -3 working days for acceptance and reply to you by e-mail or SMS.

Atomy Malaysia Sdn. Bhd. (201401043544 [1119724-A]) AJL 932143 Level 27, Menara Allianz Sentral, No 203, Kuala Lumpur Sentral, Jalan Tun Sambanthan Brickfields, 50470 Kuala Lumpur, Malaysia. Tel: +603 2718 7000 (Customer Support) E-mail : atomy_my@atomypark.com