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Final Extension Form

For Front Desk to fill in :

Package Name :

Member No : Issue Date :

Expiry Date : Balance : Sessions

For Customer (All details are compulsory to fill in) :

• Name (as per IC/Passport)

• Contact No

• NRIC No

• Only Principal Package owner is allowed to request for package extension.

I would like to seek approval to extend my package due to :

• Reason

Remarks :

a) I fully understand and agreed that this FINAL extension request is subject to Ayu Borneo
Management.
b) There will be no further extension allowed (if this final request has been approved).
c) I will allow Front Desk to photocopy my IC/ Driving License/ Passport as a proof of my
request.
d) Any remaining session(s) not utilized after the extended date will be forfeited & no refund will be
given.

Request by,

Customer’s signature
Date :

For Office Use:


Status : Approved Rejected

Remarks :

Extends until :

AM’s Name : AM’s Signature :

Date :

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