Name (required)

Username (required)

Account Email (required)

Date of Birth [dd-mm-yyyy] (required)

Phone Number (required)

Home Address (required)

Gender (required) Female Male

Are you a reseller for a skincare brand? State the brand name or NA if not applicable. (required)

Why do you want to become our reseller? (required)

Do you have basic knowledge about skincare? (required) Yes No

Social Media Username (TikTok,Twitter, Instagram & Facebook) (required)

Name (Emergency Contact) (required)

Phone Number (Emergency Contact) (required)

Beneficiary Account number (e.g. 1234986357807) (required)

Beneficiary Name (e.g. Nurul Amirah) (required)

Beneficiary Bank Name (e.g. CIMB Bank) (required)

I certify that the above information provided by me is correct.

I undertake to submit all the documents in original for verification.

By clicking here, I state that I have read and understood the terms and conditions.