China Press Smart Card Application
Form
(This application is only opened to Malaysia Residents only) |
| Annual Membership Fees RM 15.00 |
| A. Personal Details |
| Membership Type: |
New Member
Renewal Membership No.:
|
| * Title: |
|
| * Name:
|
(Chinese)
(English)
|
| * Name
On Card: |
max 25 character, no symbol : (@); (-); (/)
|
|
* IC No. (New) / Passport:
|
no space bar & no symbol : (-)
|
| Old IC No.: |
|
|
* Date of Birth:
|
Year
Month
Day |
| * Nationality: |
Malaysian
Others
|
| * Sex: |
Male
Female |
| Race: |
Chinese
Malay
Indian
Others
|
| Marital Status: |
Single
Married
|
| Mail To: |
House
Office |
| * Correspondence
Address: |
|
| City: |
|
| Postal Code: |
|
| State: |
|
Country:
|
|
| |
|
| Personal Contact |
| * Telephone
(Home): |
no
space bar & no symbol : (-) e.g. 2201234 |
| * Mobile
Phone: |
no
space bar & no symbol : (-) e.g. 2201234 |
| * Email: |
|
| |
|
| Company Details |
| Company Name: |
|
| Address: |
|
| City: |
|
| Postal Code: |
|
| State: |
|
| Designation |
Director
Manager
Executive
Business Owner
Others
|
| Telephone: |
no
space bar & no symbol : (-) e.g. 2201234 |
| Fax: |
no
space bar & no symbol : (-) e.g. 2201234 |
| Email: |
|
| Website URL: |
|
| |
|
| B. Mobile Commerce |
* Are you a TeleMoney member?
|
Yes
No
|
| * Payment Method: |
VISA Credit Card
MASTER Credit Card |
| * Issuing
Bank: |
|
| * Credit
Card Number: |
no space bar & no symbol : (-) |
| * Expiry: |
Year
Month |
| * Pin: |
must be 6 characters in number (0-9)
only and no spaces bar. |
| * Confirm Pin: |
make sure it is difficult for others to guess! |
| * Preferred
Language: |
English |
| Application For: |
1Year (RM15.00)
3 Years (RM40.00)
5 Years (RM60.00) |
| |
|
| C. Others |
| Educational Level: |
Primary
Secondary
College
University |
| Household Income: |
No Income
Below RM1,000
RM 1,001~RM 3,000
RM 3,001~RM 5,000
RM 5,001~RM10,000
Above RM10,000 |
| How do you obtain China Press? |
Long Term Ordering
Newspaper Stall
Company
Internet
Friend |
| The newspaper that you ordered at home: |
|
| Other newspaper that you read: |
Nanyang Siang Pau
Sin Chew Jit Poh
Kwong Ming Jit Poh
Kwang Hua
The Star
New Straits Times
Others:
|
| Do you read any magazine? |
None
Yes, please specify:
|
| Insurance that you are covered with: |
Life Insurance
Personal Insurance
Car / Motor Insurance
Others:
|
| Do you wish to receive our promotional message? |
Yes
No |