V25082023

Product Application Form

Customer Details
Name of Customer : NORAINIE BINTI SEPIRIN

NRIC/Passport/Company No : 910826125970

Email : CONNIELIA47@GMAIL.COM

Contact No : +60-1121608554

Address : JALAN LANDAK KWN LOT89 TAMAN ABAD 80250 80250 TAMAN ABAD JOHOR MALAYSIA

Product(s) Details
Order Date : 2024-02-06

Order No : AC003315

Outright Purchase/ Product

Plan : RENTAL PLAN

Rental Period : 60 MONTHS

Warranty Period : 60 MONTHS

Service & Maintenance Priod : EVERY 6 MONTHS

HEALTHY LIVING

Product(s) : AIR CONDITIONING

CW10V-MB3-IU - CUCKOO VITA-S AC INVERTER (1 HP) & CL10V-MB3-OU - CUCKOO VITA-S AC INVERTER COMPRESSOR (1
HP)

Delivery/Installation Address : JALAN LANDAK KWN LOT89 TAMAN ABAD 80250 80250 TAMAN ABAD JOHOR MALAYSIA

Delivery/Installation Date : The day when the Product is delivered and/or installed at the Delivery/Installation Address

Outright Purchase Price : -

Obligatory Period : 1 - 60 MONTHS

Monthly Rental : Remaining Period : -

1-12 Months 13-24 Months 25-36 Months 37-48 Months 49-60 Months

RM 98.00 RM 98.00 RM 98.00 RM 98.00 RM 98.00

Early Termination Fee : Total Monthly Rental Sum for Obligatory Period - Total Paid Rental

Total Loss Fee : Total Monthly Rental Sum - Total Paid Rental

Advanced Fee : RM 98.00

Processing Fee : -

Promotion Code : CUCKOO VITA-S AC INVERTER - WAIVE RPF ( VITAS-REN-RPF2023 ) : Waive RM250 Processing Fees

I/We hereby declare that:

o I/We wish to outright purchase the Product(s) or subscribe to the Product Plan.

o The information provided by me/us is true and correct.

o I/We have read, accepted and agreed to be bound by the terms in https://app.cuckoo.com.my/STCP_GTCP/AC_v2.0.pdf (GTCP & STCP) and the above as well as any
amendments provided to you via email, SMS or CUCKOO+APP and the same shall be read together and considered as one original and binding agreement between me/us
o I/We hereby consent to the collection and processing of my/our personal data in accordance with CUCKOO’S Privacy Notice (at https://www.cuckoo.com.my/pdpa-consent ).
I/ We further agree and accept that the terms and conditions in the CUCKOO’s Privacy Notice form an integral part of the terms and conditions of the outright purchase or
Product Plan.

Signed by )
NORAINIE BINTI SEPIRIN
)

910826125970 )

Signatory Name :
Signatory NRIC :