PT. ALFA SEHAT INDONESIA
New Member Registration
Registration
Step : |
1. Fill data
| 2. Confirmation | 3. Welcome letter
Step 1 : Fill data
User & Sponsor Information
User Name
*
:
Password
*
:
Confirm Password
*
:
Transaction Code
*
:
User Name Sponsor
*
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User Name Placement
*
:
Position
*
:
Left
Right
Personal Information
Full Name
*
:
Mobile Phone No.
*
:
*
Example : 08121234567, 02191234567
( for CDMA, use area code )
Email
*
:
Country
*
:
Select Country
INDONESIA
MALAYSIA
THAILAND
PHILIPINA
MYANMAR
VIETNAM
CAMBODIA
SINGAPORE
ID Number
*
:
KTP
SIM
PASSPORT
/
Birth Date
:
Gender
:
Male
Female
Bank Account Information
Bank Account No.
*
:
Bank Account Name
*
:
Please make sure your bank account is valid so the bonus can be transferred
Bank
*
:
Select Bank
Bank Central Asia (BCA)
Bank Mandiri (BMI)
Bank Negara Indonesia (BNI)
Bank Danamon (BDN)
Bank Inernational Indonesia (BII)
Bank Rakyat Indonesia (BRI)
CIMB Niaga
BANK PERMATA (BPM)
PUBLIC BANK (MY)
MAY BANK (MY)
HONG LEONG BANK (MY)
CIMB BANK (MY)
HSBC BANK (MY)
OCBC BANK (MY)
STANDARD CHAT (MY)
AMBANK BERHARD (MY)
RHB (MY)
Alliance Bank (MY)
Bank Simpanan (MY)
AFFINBANKBERHAD(MY)
BANK ISLAM (MY)
BANK RAKYAT (MY)
UOB BANK (MY)
Al-Rahji Bank (MY)
BANK MUAMALAT (MY)
Bank Branch
*
:
Bank City
:
Tax Payer Number ( NPWP )
*
:
Tax Payer Name
*
:
Approval of Membership
*
:
I have read and I agree with PT. ALFA SEHAT INDONESIA
Terms and Agreement of Membership
Fill the code below
*
:
Click code to get new code
*
All field are compulsory.
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