APPLICATION FORM

Application Type :

Independent Wellness Consultant

Preferred Customer

INDEPENDENT WELLNESS CONSULTANT INFORMATION

Applicant Type :

Individual

Corporation

Name of Applicant :

(As Shown In NRIC / Passport)

NRIC No. :

Name of Company :

Bussness Reg. No. :

Address :

Postal Code :

Date of Birth :

(dd-mm-yyyy)

Sex :

Female

Male

Email Address :

Tel (Home) :

Tel (Office) :

Mobile :

CO-APPLICANT INFORMATION

Name of Co-Applicant :

(As Shown In NRIC / Passport)

NRIC No. :

Date of Birth :

(dd-mm-yyyy)

GIRO PAYMENT DETAILS

Bank Name :

Bank Branch :

Account No. :

Name of Account Holder :

SPONSOR INFORMATION

Name of Sponsor :

Sponsor's I/D No. :

Tel (Home) :

Tel (Office) :

Mobile :

TERMS AND CONDITIONS

Upon submit, I/We hereby acknowledge that I/We have read the agreement and I/We also agree that I/We will abide with all of Nikken Policies and procedures.
I/We am/are of legal age 21 years old.
I/We are Permanent Resident(s) or Citizen(s) of Singapore.
I/We understand a Preferred Customer reserved the rights to stay as a Customer or choose to become an Independent Wellness Consultant.
I authorise Nikken Wellness Singapore Pte Ltd to credit my monthly commission to the above bank account. (Applicable only to consultant)
I/We certify that the above is correct and will be responsible for the information provided.
This application can be cancelled within sevent (7) days from date of submission
I/We am/are to conduct our Nikken business in abeyance to the law of Singapore.
The Company reserves the right to make ammendments as and when necessary to the above.