SLEEPING PARTNER Application Form

SLEEPING PARTNER APPLICATION

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DIAMOND BOSS

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DIAMOND MEMBER

PERSONAL INFORMATION

Full Name*

NRIC No.*

Contact No.*

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Address*

Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code

Email Address*

Partner | Code*

New Password*

*Login password for healthiediamond.com

Confirm Password*

Bank Account No*

BD/Partner Name

BD/Partner Code

CATEGORY

Direct Customer

iMember Customer

REFERRAL BY

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iMember/SP Partner Name

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iMember/SP Partner Code

VERIFIED BY BIZ DIRECTOR

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Biz Director Name

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Biz Director Code

DECLARATION

Agree*

I hereby request to apply for Healthie DIAMOND Sleeping Partner and I have read and fully understand and agree to be abided by the terms and conditions of the Healthie DIAMOND Sleepping Partner.

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Sponsor

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Verify