Confirmation of Nomination

Company Name (E) :
 _______________________________________________________________
(C) :
_____________________________________ ROC No : _________________
Business Address :

_______________________________________________________________
_______________________________________________________________

_______________________________________________________________

Telephone :
 ___________________________ Fax : _______________________________
E-mail :
 ___________________________ Website : ___________________________
Business Nature :
________________________________________________________________

________________________________________________________________
No.Of Employees :
 ___________ Annual Sales Turn Over (USD) : ________________________
Primary
Product/ Services :
 ________________________________________________________________

________________________________________________________________
Achievement
(Award, ISO and etc.,) :
 ________________________________________________________________

________________________________________________________________
Name of the person receiving the award :
____________________________ Chinese Name (if any) : ______________
Designation :
 ____________________________ Direct Phone : ______________________
New IC No :

____________________________ Handphone : _______________________

By submitting this application form, we hereby agree that :-

  1. To pay a non-refundable authentican fee of RM 100.00 (Malaysia company) or USD 200.00 (foreign company) to the organiser (cheque payable to the Event Manager e-Dynasty Holdings Sdn. Bhd.).
  2. To participate in the sponsorship program and the sponsor fee must be paid within 10 working days after receiving the official mail notification of winning.

    3. Declaration :-
    I am an authorized representative of the company with full power and authority to sign and deliver this application. The company listed on this application agrees to comply with all policies, rules and regulation adopted by the organiser from time to time. I also declare that the facts stated in this nomination together with the accompanying information are true, correct and have satisfied the eligibility criteria.


Attachment
1. Company Registration ( Form 49 ) - photocopy
2. Corporate Profile
3. Award Recipient's 5R photographs (formal) 4 pcs.
4. Company's Logo (if in soft copy, minimum 500KB)
5 . Any relavant documents to support this nomination




__________________________________
Signature and Company Chop (required)
Name :
Designation :