MY SENSES Agent Application Form (Guest Form)
Applicant’s full name as per IC:
New I/C No (eg.901103109313):
Accepted file types: png, jpg, jpeg, pdf.
Upload Selfie Photo
Accepted file types: png, jpg, jpeg, pdf.
Vertical Photo 打直的照片
Date of Birth
Date Format: DD slash MM slash YYYY
Mobile Phone No:
House Phone No:
Address Line 2
State / Province / Region
ZIP / Postal Code
Antigua and Barbuda
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
British Indian Ocean Territory
Central African Republic
Congo, Democratic Republic of the
Congo, Republic of the
French Southern Territories
Heard and McDonald Islands
Isle of Man
Lao People's Democratic Republic
Northern Mariana Islands
Palestine, State of
Papua New Guinea
Saint Kitts and Nevis
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Sao Tome and Principe
Svalbard and Jan Mayen Islands
Trinidad and Tobago
Turks and Caicos Islands
US Minor Outlying Islands
United Arab Emirates
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Bank Name (must be own a/c):
Affin Bank Berhad
Alliance Bank Malaysia Berhad
AmBank (M) Berhad
CIMB Bank Berhad
Hong Leong Bank Berhad
Malayan Banking Berhad (Maybank)
Public Bank Berhad
RHB Bank Berhad
Bangkok Bank Berhad
HSBC Bank Malaysia Berhad
OCBC Bank (Malaysia) Berhad
Standard Chartered Bank Malaysia Berhad
United Overseas Bank (Malaysia) Berhad (UOB)
Bank Islam Malaysia Berhad
Bank Simpanan Nasional
Bank Account No:
Confirm Bank Account No:
Have you ever been a My Senses Agent before?
Your Referral Agent Details:
Referral Agent Name:
Referral Agent ID:
I do not have a referral agent, please assign one for me:
IF MY APPLICATION TO BECOME A MY SENSES AGENT IS ACCEPTED, I UNDERSTAND, REPRESENT AND AGREE THAT:
1. I am acting in my own behalf as an individual and I am 18 years of age or older.
2. This application shall constitute a binding agreement between Senses World Sdn. Bhd. (hereafter referred to as My Senses) and myself at such time as this application is received and approved by My Senses in Malaysia.
3. I acknowledge that I have selected a Referrer or have had one assigned to me, which I accept.
4. I am an independent agent in the business of selling consumer products. I am not an employee of legal representative of My Senses for any purpose. I will be responsible for compliance with federal, state and local statutes, including, but not limited to, those relating to licensing and taxation.
5. I recognize that my remuneration is based on my performance in the sale or delivery of products and not on the number of hours worked or an element of chance.
6. My Senses shall not be responsible for withholding or collection and remitting of any taxes unless required by statutes and regulations or by express collection agreement with the relevant authority.
8. My Senses may, after reasonable notice, change, amend or modify this agreement and its policies, procedures and marketing plan to maintain a viable marketing system, comply with legal requirements or changes in economic conditions, and I shall operate my business in accordance with any such changes, amendments or modifications.
9. To properly represent My Senses’ products and its marketing plan, all forms of advertising, including, but not limited to, audio and video, images and printed material, must be submitted and approved in writing by an authorized My Senses’ representative prior to use.
10. I MAY CANCEL THIS AGREEMENT AT ANY TIME EFFECTIVE UPON MAILING WRITTEN NOTICE TO MY SENSES.
11. This agreement is personal in nature and cannot be assigned or transferred, except in the event of my death, wherein an individual who can qualify as a My Senses Agent may inherit the same.
12. My Senses expects its Agents to conduct themselves with highest ethics and integrity. I agree to do so and represent that I have never been convicted of a felony or charged with a crime involving moral turpitude or dishonesty.
13. I understand that this application is subject to a COOLING-OFF PERIOD OF 10 WORKING DAYS. Anytime during this period, I may cancel and withdraw my application.
I accept and agree with the above terms and conditions:
I AGREED PDPA
In view of the implementation of the Personal Data Protection Act 2010 ("Act"), My Sense is a brand owned by Senses World Sdn Bhd. ("My Senses") recognize the need to process all personal data obtained in a lawful and appropriate manner.
By submitting this Form, you hereby agree that My Senses may collect, obtain, store and process your personal data that you provide in this form for the purpose of receiving updates, news, promotional and marketing mails or materials from My Senses.
You hereby give your consent to My Senses to:
1. Store and process your Personal Data.
2. Disclose your Personal Data to the relevant governmental authorities or third parties where required by law or for legal purposes.
3. Your personal data may be transferred to any company within the My Senses which may involve sending your data to a location outside Malaysia. For the purpose of updating or correcting such data, you may at any time apply to the My Senses to have access to your personal data which are stored by My Senses.
For the avoidance of doubt, Personal Data includes all data defined within the Personal Data Protection Act 2010 including all data you had disclosed to My Senses in this Form.
My Senses may amend this Privacy Statement from time to time and the updated version shall apply and supercede any and all previous versions, including but not limited to, leaflets or hard copy versions. Please check our website www.mysensesworld.com for information on our most up-to-date practices.
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