WELCOME TO TOTAL ASSIST - MEMBERSHIP APPLICATION

NO HASSLE,° NO FEAR ° NO GIMMICK ° NO JOKE

Total Assist Membership Application Form
New/ Baru			Renewal/ Pembaharuan
A. Personal Particulars/ Butir Peribadi
1. Name/ Nama
2. NRIC/ PP No./No. KP/Paspot		3. Nationality/ Kewarganegaraan
4. Date of Birth/ Tarikh Lahir	DD MM YY	5. Sex/ Jantina	Male/Lelaki Female/ Perempuan
6. Mailing Address/ Alamat Surat-Menyurat
7. Telephone No./ No. Telefon		7a. (Residence/ Kediaman)
		7b. (Mobile/ Telefon Bimbit)
B. Emergency Contact/ Perhubungan Kecemasan
1. Name/ Nama
2. Relationship/ Pertalian		3. Telephone No./ No. Telefon
C:. Employment/ Business Particulars/ Maklumat Pekerjaan/ Perniagaan
1. Occupation/ Pekerjaan
2. Name of Employer/Business/ Nama Majikan/ Perniagaan
3. Address of Employer/Business/ Alamat Majikan/ Perniagaan
4.Telephone No./ No. Telefon
D. Vehicle/ Driving Particulars/ Maklumat Kenderaan/ Memandu
1. Reg. No./ No. Kenderaan		3. Mfg Year/ Tahun Diperbuat
2. Model/ Jenis		4.Colour/ Warna
5. Name of Insurer/ Nama Syarikat Insuran
6. Type of Insurance/ Jenis Insuran	Comp 3rd Party	6a. Expiry Date/ Tarikh Luput	DD MM YY
7. Expiry Date/ Tarikh Luput		7a. Driving Licence/ Lesen Memandu	DD MM YY
		7b. Road Tax/ Cukai Jalan	DD MM YY
E. Membership Payment/ Bayaran Keahlian
		1 Year/ 1 Tahun	2 Years/ 2 Tahun
1. Total Standard/ Kad "Standard"		RM100	RM170
Total Gold/ Kad Emas		RM120	RM200
2. Credit Card/ Kad Kredit (Will continue to online payment after submiting this form)			Cheque/Draft/Cek/Draf Enter Cheque or Draft Details if Any/ Isikan Butir Cek Atau Draf Jika Ada Crossed "A/C Payee" made out to/Dipalang Atas Nama: KLF Total Assist (M) Sdn. Bhd.
			Bank:	Cheque No/No Cek:
By submitting this form, I hereby request for the service to be supplied to me and willingly supply the above information to KLF Total Assist (M) Sdn. Bhd. I declare that the above information given by me is true and valid. KLF Total Assist (M) Sdn. Bhd. reserves the right to terminate the service at any time without making any refund of whatever monies held by KLF Total Assist (M) Sdn. Bhd. should any of the above information is found to be untrue. I declare that by using the service I agree to be bound by membership terms and conditions as shown in the membership handbook or any amendments made thereto. I agree that this shall be governed by the Total Assist membership terms and conditions and that KLF Total Assist (M) Sdn. Bhd. has the right to add, change, modify or withdraw any benefit under the Total Assist card programme from time to time without any prior notice to members. Dengan menyertakan borang ini, saya memohon supaya perkhidmatan di bekalkan kepada saya dan saya dengan relanya membekalkan maklumat di atas kepada KLF Total Assist (M) Sdn. Bhd. Saya mengesahkan bahawa maklumat di atas adalah benar dan sah. KLF Total Assist (M) Sdn. Bhd. mempunyai hak membatalkan keahlian pada bila-bila masa tanpa memulangkan sebarang wang yang dipegang oleh KLF Total Assist (M) Sdn. Bhd. jika didapati bahawa maklumat di atas adalah palsu. Saya sedia mematuhi segala syarat-syarat perkhidmatan seperti yang dipamerkan di dalam buku panduan keahlian dan segala pengubahan yang d buat seterusnya. Saya setuju bahawa ini dimantaukan oleh syarat-syarat Total Assist dan KLF Total Assist (M) Sdn. Bhd. berhak menambah, menukar, mengubah suai atau menarik balik mana-mana faedah di bawah program kad Total Assist dari masa ke masa tanpa di maklumkan terlebih dahulu kepada ahli-ahli.

The Programme:

>> Concept
>> Objectives
>> Services & Symbols
>> Membership Types & Fees
>> Why We Are Different
>> Membership Eligibility
>> Membership Benefits
>> Download TAP & Member's Handbook
>> Membership Application
>> Contact Information