TESTIMONIAL CONDITION FORM

COMPULSORY – BOTH FTA & INVITER NRIC/PASSPORT (S) MUST BE ATTACHED TO THIS
FORM OTHERWISE REGISTRATION IS VOID.

PLEASE COLLECT BACK YOUR NRIC/PASSPORT (S) ONCE REGISTRATION IS COMPLETED.

Date: ____/_____/ 2015

1) Particulars of Testimony Provider

i) Name: ……………………………………………………………………………………………………
ii) NRIC/PASSPORT No. : …………………………………………………………………………….
iii) Contact No: ……………………………………………………………………………………………
iv) E-mail Add. : …………………………………………………………………………………………..

2) Particulars of Inviter

i) Inviter Name: ……………………………………………………………………………………………………

ii) Inviter NRIC/PASSPORT No. : …………………………………………………………………………….
iii) Inviter Contact No: ……………………………………………………………………………………………
iv) Inviter E-mail Add. : …………………………………………………………………………………………..

I, the above mentioned Name and holder of the NRIC/Passport stated herein above under
items (1) (i) and 1 (ii) hereby confirm and warrants the followings :-

a) I will submit my Medical Report or Before/After photos as my testimonial proof

b) I agree to fill up the attached testimonial form
c) I agree to indemnify Destina1 International (D1’) for the price of the product/
gift/prize that was given to me for providing testimony.
d) I further authorise D1’ to deduct the said amount from my D1’ account E-Wallet (if
have any) false representation for product/gift/prize/

Signature of …………………………………………………………………………….

Name: _______________________________________

Date: ____/_____/2015

All of the above mentioned terms shall be subjected to the Terms & Condition of the “Gift
Promo for testimonial provider” currently being carried out by D1’ in 2015.

(Note: All items 1(i) - 1(iv) and 2(i) - 2(iv) must be completely filled in and all the
conditions mention above has to be fulfil or otherwise the testimonial condition form is
considered void).