TRANSFER OF FACILITY FORM

Executive Name : Branch :

Agency Name :

Account Code :

Agency Status :

Suspend / Terminate Date :

TRANSFER OF FACILITY (please tick where applicable)

PC Printer

Transfer to :

Agency Code :

Gross Production :
Period (for new agent) : From : ............................. To : .............................

New Installation Address :

Telephone No. : Fax No. :

Person in Charge :

Recommendation by Marketing Executive :

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Signature : ______________________ Date : _______________________

Remarks by Branch Manager :

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Signature : ______________________ Date : _______________________

Approval by Regional Manager / Authorised Personnel : Yes No

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Signature : _____________________ Designation : ____________________ Date : __________________