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Room :
MH 1
MH 2
Date :
Name :
Membership :
Identity No. (e.g. 801212124183):
Contact No. (H/P):
Contact No. (H):
Contact No. (O):
Address 1 :
Address 2 :
Postcode :
City :
State :
Johor
Kedah
Kelantan
Kuala Lumpur
Labuan
Melaka
Negeri Sembilan
Pahang
Perak
Perlis
Penang
Sabah
Sarawak
Selangor
Terengganu
Purpose :
Date From :
Date Till :
Deposit (RM) :
Payment Receipt
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Receipt Upload :
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