V25082023
Product Application Form
Customer Details
Name of Customer : MOHD NOOR BIN RAFI'E
NRIC/Passport/Company No : 800911016093
Email : MYNURNA@YAHOO.COM
Contact No : +60-197337255
Address : 158 BLOCK 8, FELDA AIR TAWAR 5, KOTA TINGGI JOHOR 81920 AYER TAWAR 5 JOHOR MALAYSIA
Product(s) Details
Order Date : 2024-07-07
Order No : AC197342
Outright Purchase/ Product
Plan : GooodPlan
Rental Period : 60 MONTHS
60 MONTHS
Warranty Period :
Service & Maintenance Priod : EVERY 4 MONTHS
HEALTHY APPLIANCE
Product(s) : WATER PURIFIER
CP-AEN501HW - KING TOP 2
Delivery/Installation Address : 158 BLOCK 8, FELDA AIR TAWAR 5, KOTA TINGGI JOHOR 81900 KOTA TINGGI 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 : -
1-60 months
RM 55.00 RM 0.00 RM 0.00 RM 0.00 RM 0.00
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 55.00
Processing Fee : -
King Top RM 55 Goood Plan ( KT55GDP ) : Contract End Customer with Trade In
Promotion Code :
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/WP_KingTop2_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
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 )
MOHD NOOR BIN RAFI'E
)
800911016093 )
Signatory Name : MOHD NOOR BIN RAFI'E
Signatory NRIC : 800911016093
