Personal Details:
Details of Insured:
NAME | DATE OF BIRTH | PASSPORT NO. | NATIONALITY |
---|---|---|---|
Full name | dd/mm/yyyy | ||
Full name | dd/mm/yyyy | ||
Full name | dd/mm/yyyy | ||
Full name | dd/mm/yyyy | ||
Full name | dd/mm/yyyy |
Membership Plans:
BRONZE | SILVER | GOLD | PLATINUM | |
---|---|---|---|---|
ADULT | RM 150 | RM 250 | RM 350 | RM 500 |
CHILD (5-18) | RM 75 | RM 75 | RM 75 | RM 75 |
Fees:
Adult x quantity = Total
Child x quantity = Total
Joining Fee: RM150
Subtotal
SSt 6% of the subtotal amount
Total Fee Due: