Herbalife Products Malaysia Sdn. Bhd.

(282141-M) (AJL 931586)

Ground Floor Plaza See Hoy Chan
Jalan Raja Chulan
50200 Kuala Lumpur

ORDER PICK UP AUTHORIZATION LETTER

I. __________________ (Name) bearing Herbalife ID: ___________ hereby authorize the following
person

Name:
Herbalife ID / NRIC :
Contact:

Signature:

to pick up my order _______________ ( Order #) for and on my behalf.

In order to avoid any fraudulent collection, the authorized person shall provide his/ her proof of
identification for verification purpose by Herbalife. The authorized person shall check the contents of
the order, and if any discrepancies found he/she is required to inform the counter agents immediately.

I hereby confirm that the signature of the above mentioned authorized person confirming collection of
the Order mentioned herein shall binding on me personally and shall constitute legal acknowledgment
of receipt of the said Order by myself and shall fully discharge Herbalife of all its obligations with
respect to the delivery and / or collection of the Order. This arrangement shall be completely at my
own responsibility and risk and Herbalife shall not be responsible and liable in this regard, under any
circumstances, should the Order be collected by the abovementioned authorized person and I hereby
absolve Herbalife from any such liability and waive any claims against Herbalife in this regard.

Thank you,

Yours Truly,

____________________________
Name:
Contact:
Date: