Distributor Application Form 
         Please fill out information in the white box. Italic words are just examples for your reference. If you have questions about how to fill information, please call 0944X
                Application for                                  Distributor
                Region                                                       Bago
                Postal Codes                                 02-00
                City                         Yangon                 State                   Bago
                                                                         Personal Information 
                Name                                  John                                                       Smith
                                   First                                      Middle & Last
                Date of Birth                7/1/1990           25-30
                Phone No.                    0944XXX
                Email ID           JohnSmith@hotmail.com
                Permanent Residential Address
                Upper Pansodan road
                Office Address
                Bo Soon Pat road
                                                                          Business Outlook
                Source of Funds    Own Finance                                Comments - Additional Information 
                Investment 
                Capacity (Kyats)   < 7.5 Million
Distributor Application Form 
Please fill out information in the white box. Italic words are just examples for your reference. If you have questions about how to fill information, please call 0944X
Bago
      Bago
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Personal Information 
                        Smith
                      Gender               Male
                      Mobile No.          0944XXX
                                     Yangon
                      City
                                     Yangon
                      City
Business Outlook
Comments - Additional Information