Website : www.ppeoc.

my

Registration Email : register@ppeoc.my

(Kindly complete this form and send via email to register@ppeoc.my –PPEOC Admin )

A. Personal Details

NAME :

IC. NO :

DATE OF BIRTH :

PLACE OF BIRTH :

CORRESPONDENCE ADDRESS :

POSCODE :

CITY/TOWN :

STATE :

COUNTRY : MALAYSIA

ADDRESS FOR STICEKER POSTING : *if different with the above address

MOBILE PHONE NO. :

HOME/OFFICE TEL. NO. :

EMAIL :

B. Vehicle Registration

VEHICLE REG. NO :

CAR MAKER : PROTON

MODEL : PERSONA ELEGANCE

ENGINE CAPACITY : 1.6 A

YEAR MANUFACTURE : 2010

COLOR : BRONZE
 C: Sticker Order

1. PPEOC Sticker (4” x 4”) Color Quantity

Sample: Bronze Garnet
Chiffon Green
Tranquility Black
Brilliant Red
Genetic Silver
2. PPEOC Sticker-Rear (15” x 4”)

Default

Sample:

D: Administration (For Administrator Used ONLY)

RECEIVED DATE :

APPROVED DATE :

PAYMENT BY :(CHEQUE/BANKIN/CASH)

MEMBERSHIP NO. : PE_ _ _ _

AFFECTIVE DATE :