FRANCHISE BUSINESS APPLICATION

LOCATION INTENDED : NAME OF APPLICANT : NEW NRIC NO. : OLD NRIC NO. :

PERSONAL INFORMATION OF POTENTIAL FRANCHISE Single N!"#er o$ C%ildren: Ot%er Dependent : O&n Ho"e Ho"e Pa'"ent( Rental pa'"ent( RM I$ %o!(e o&ner)"ont%l' pa'"ent( RM APPLICANT Na"e : Telep%one : Addre(( : *irt%date : Physical Information Heig%t : Weig%t : APPLICANTS SPOUSE Na"e : Telep%one : Addre(( : *irt%date : Physical Information Heig%t : Weig%t : per "ont% Rent Separated Married Age : Divor ed

P%'(i al li"itation( or %ealt% on ern( : Ed cation R!cord " Hig% S %ool LCE MCE College + ,niver(it' Em#loym!nt R!cord of A##licant C!rrent E"plo'er : Addre(( : Pre(ent Salar' : De( ription o$ &or- :

P%'(i al li"itation( or %ealt% on ern( : Ed cation R!cord " Hig% S %ool LCE MCE College + ,niver(it' Em#loym!nt R!cord of A##licant C!rrent E"plo'er : Addre(( : Pre(ent Salar' : De( ription o$ &or- :

Page 1 of 5

F/2008

PRE$IOUS BUSINESS O%NE& Have 'o! ever o&ned 'o!r o&n #!(ine(( or ot%er t'pe o$ *!(ine(( . I$ (o give t%e $ollo&ing detail(. *!(ine(( Na"e : Ho& Long O&ned : Addre(( :

Ho& "an' e"plo'ee( : Nat!re o$ *!(ine(( : Are 'o! an Avon Dealer . I$ 'e(0 &%at i( 'o!r LOA &it% Avon /e( : No

Pa(t pa'"ent e1perien e &it% Avon : Stat!( a %ieved : ,M ,D : ,E Ordinar' Dealer

C!rrent #alan e o&ing to Avon

Area intended to (et !p Avon P!teri : C!rrent per(onal (to - #alan e on %and : RM

FINANCIAL INFOR'ATION Net Wort% S!""ar' C!rrent A((et( Ca(% in !rrent A+C RM C!rrent Lia#ilitie( Note Pa'a#le RM S%ort Ter" Loan RM Total C!rrent Lia#ilitie( RM Fi1ed A((et( Propert'0 %o!(e Ot%er A((et( De( ri#e RM RM RM RM RM S%are( A!to"o#ile( Mone' d!e to 'o! Total Total A((et( RM RM Total Lia#ilitie( RM Long Ter" Lia#ilitie(

Ca(% in Saving( A+C RM Total C!rrent A((et( RM

Net Wort% 2A((et( 3 Lia#ilitie(4 RM Ho& "! % apital an 'o! allo ate $ro" t%e a#ove (o!r e( to (et !p t%i( $ran %i(e : RM I$ t%e re5!ired a"o!nt i( not availa#le %o& &o!ld t%e inve(t"ent #e o#tained :

S%o!ld 'o! re5!ire additional $!nd on a ad%o #a(i(0 &ill 'o! #e a#le to do it . /e( I$ 'e(0 %o& . Do 'o! plan to onvert t%e a#ove a((et into a(%. /e( No No

Do 'o! plan to %ave partner . I$ 'e(0 &ill t%e partner #e a tive .

/e( /e(

No No

&!tails of Partn!r PARTNER Na"e : Telep%one : Addre(( : *irt%date : P%'(i al li"itation( or %ealt% on ern(: Ed! ation Re ord : Hig% S %ool LCE MCE College + ,niver(it' Em#loym!nt R!cord of A##licant C!rrent E"plo'er : Addre(( : PARTNERS SPOUSE Na"e : Telep%one : Addre(( : *irt%date : P%'(i al li"itation( or %ealt% on ern(: Ed! ation Re ord : Hig% S %ool LCE MCE College + ,niver(it' Em#loym!nt R!cord of A##licant C!rrent E"plo'er : Addre(( :

Pre(ent Salar' : De( ription o$ &or- :

Pre(ent Salar' : De( ription o$ &or- :

Will 'o! #e operating 'o!r o!tlet. Will 'o! #e %iring a((i(tant( . Do 'o! plan to %ave inve(tor . I$ 'e(0 to &%at e1tent .

/e( /e( /e(

No No No

W%at i( t%e "ini"!" in o"e 'o! need to "aintain 'o!r $a"il' d!ring t%e $ir(t 'ear o$ #!(ine(( : RM Ot%er in o"e (o!r e( . W%en do 'o! &ant to (tart 'o!r $ran %i(e operation . Ho& did 'o! %appen to #e o"e intere(ted in t%i( parti !lar $ran %i(e .

W%at i( 'o!r per(onal goal . 6 "ont%( $ro" no& 7 'ear $ro" no& 8 'ear( $ro" no& : : :

9 'ear( $ro" no& : State 'o!r rea(on( $or #elieving 'o! &ill #e a#le to (! e(($!ll' operate one o$ o!r $ran %i(e and to provide an' additional in$or"ation 'o! #elieve &ill advan e 'o!r appli ation.

This a##lication for consid!ration do!s not o(li)at! yo in any *ay nor do!s it im#ly th! a##ro+al or )rantin) of a franchis! or lic!ns! a)r!!m!nt (!t*!!n yo and A+on Cosm!tics ,'- Sdn Bhd.

STATE'ENT OF &ECLARATION I erti$' t%at t%e in$or"ation provided a#ove i( valid and o"plete. Avon Co("eti ( 2M4 Sdn *%d i( a!t%ori:ed to ond! t an inve(tigation report+in5!ir' t%at i( dee"ed ne e((ar' in order to veri$' t%e a !ra ' o$ t%e in$or"ation a#ove and to deter"ine "' redit &ort%ine((+$inan ial (tanding.

APPLICANTS SI/NATURE

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