Wisma Kenshido, No 1-1, 1-2, 1-3, Jalan PJU 5/6 Dataran Sunway PJU 5, 47810 Kota Damansara, Petaling

Jaya,
Selangor, Malaysia.
Tel : 603-6141 7828 (Hunting Line) Fax : 603-6141 8126, 6141 8136
Website : www.i-learning.asia Email : enquiries@kenshido.com SPM (ART)
SPM (SCIENCE)

PARENT ID
APPLICATION FORM PASSWORD

Applicant Name :
Applicant I/C No. :

Address :

Contact No : (H) (O) (H/P)

CHILDREN DETAILS

NO. NAME I/C No. AGE YEAR/FORM SCHOOL NAME

PAYMENT METHOD CASH : __________________________________

RM398 quarterly 6 months CHEQUE
+ RM 60 (One time activation code) = RM458.00 Cheque no._______________________________
RM856 yearly (For 1-2 dependent) Bank ___________________________________

PROMOTION RM458 yearly (Until 31 Dec 2017) CREDIT CARD * (if card is not presented)
Card no __________________________________
Card Code________________________________
To add dependent, Card Expiry Date __________________________
pay only RM60 for each activation code. Card Holders Name ________________________
Required documents (Photocopy):
Payable to: KENSHIDO INTERNATIONAL SDN BHD
1. IC ( front and back )
MAYBANK ACCOUNT NO: 5142-7112-9756 2. Credit Card ( front and back )
TOTAL : RM __________________
3. Credit Card Authorisation Letter
* 2.75% Admin Charges for Mail Order
Card Holders Signature
To add 3rd dependent (or more), activation will be done by the customer
service department in HQ. Please provide childs birth cert for all child's
as a proof.

Note : If you would like to return the activation / top-up code for a refund within *Terms & Conditions apply
the 10-day cooling-off period, kindly fill up the Refund Form together with the
official receipt OR refer to the distributor from whom you purchased the goods.
The activation / top-up codes issued is not refundable after the 10-days-cooling-
off period. All claims whatsoever will not be entertained.
APPLICANT'S SIGNATURE DATE
OFFICE USE ONLY
SERIAL NO / ACTIVATION CODE ________________________________________ ACTIVATED BY __________________
SERIAL NO / TOP-UP CODE ________________________________________ CHECKED BY __________________
DATE _____________________