(HA) Rental Ownership Transfer Requisition (ROT)

ROT Reference Number
Rental Agreement Particulars
Order No.*
7 digits only
Model*
Installation Date (1st)*

DayMonthYear
Date
SOF No.*
SOF Date*

DayMonthYear
Date
Request Date*

DayMonthYear
Date
Current Rental Fee*
Previous Rental Outstading*
Previous Customer Particulars
Full Name as per I/C or Company Name*
NRIC (New) / Passport / Company No.*
without '-'
Tel (Mobile)*
without '-'
Customer Transfer Reason*
Previous Customer Signature / Name /Date*

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New Customer Particulars
Tan SriDatoDatinDrMrMrs.Ms.
Full Name as per I/C or Company Name*
NRIC (New) / Passport / Company No.*
without '-'
Email (1)
example@example.com
Installation Address (Malaysia Only)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Installation Address (Malaysia Only)*

Address (Max 70 letters including space) 0/70
Address 2 (Max 35 words including space)
State*
Postcode*
5 digits only
Tel (Mobile) (1)*
without '-'
Tel (Residence) (1)
without '-'
Tel (Office) (1)
without '-'
Tel (Fax) (1)
without '-'
Ext
Other Particulars of the new Customer (Applicable to Individual Only)
Date of Birth

DayMonthYear
Date
MalayChineseIndianKoreanOther
MaleFemale
Default SMSEmail
Mobile (1)Mobile (2)
Email (1)
Email (2)
example@example.com
Additional Service Contact Person(For Service Appointment)
Second Contact Person
Tel (Mobile) (2)
without '-'
Tel (Residence) (2)
without '-'
Tel (Office) (2)
without '-'
Ext.
Tel (Fax) (2)
without '-'
Corporate Customer Billing Information
Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
State
Postcode
Billing Contact Person
Tel (Office)
without '-'
Ext.
Department
Email InvoicePaper Invoice (Applicable to Government agencies & banks only)Upload via Vendor / Supplier's Portal Web Address (URL)
Email
example@example.com
URL
Tax Identification Number (TIN)
11 to 14 alphanumeric
SST Number
For Customer who have 2 sets of SST (Sales Tax No & Service Tax No registered separately), the way to key in will come with comma “ ; ” & no space
Payment Particulars (minimum one (1) month rental fee in advance is compulsory)
Cash / Online PaymentChequeCredit / Debit Card
Total Amount (RM)*
TR No.
Auto / Direct DebitAdvance 1 / 2 yearsE-PortalRegular (Company only)
Credit Card / Debit Card Auto Debit Authorisation3rd party Payee Payment Authorisation
Credit Card / Debit Card Auto Debit Authorisation

I/We hereby authorise Coway (Malaysia) Sdn. Bhd. ("Coway") to charge Amount (RM) per transaction to my / our debit / credit card immediately.
Charge Amount (RM)*
Card No. (First 6 Digits)*
Card No. (Last 4 Digits)*
Cardholder Name*
Signature

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Third Payee Payment Authorisation

I/We [Name][NRIC/Co.No] hereby authorise payments for this Order to be
charged to/deducted from my credit card/debit card/savings account, as a third party payee.
Name*
NRIC/Co.No*
Contact No. (Mobile)
A copy of IC / SSM and Credit / Debit Card / Bank Statement submittedA copy of Direct Debit Form for charging my savings account submitted.
Savings account no.*
For Corporate Customer Only
Issuing Bank*
Signature*

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THIS CONTRACT IS SUBJECT TO A COOLING-OFF PERIOD OF TEN WORKING DAYS

(Service will only be done after the cooling-off period unless customer agrees to waive this clause)
Declaration

I/We, the New Customer, hereby accept all rights, obligations and liabilities as a transferee under the existing agreement in place of the Previous Customer and agree to pay a minimum of one-month rental fee in advance.

I/We confirm that the particulars stated above are true and accurate.

I/We, have read and understood the terms and conditions stated herein and in the existing agreement and agree to be bound by the same.

I/We further acknowledge that COWAY reserves the right, in its sole and absolute discretion, to vary the Terms and Conditions in the SOF (“T&Cs”), and by signing this ROT Form, I/We irrevocably agree to accept all such amended terms, in addition to the T&Cs and to be bound by the SOF as continued on the reverse side of this ROT Form.

I/We declare that
(I) the particulars stated above are true and correct;

(II) I/we have read and agree to be bound by the Terms and Conditions set out herein and on the reverse side of this Form;

(III) I/we the undersigned hereby give my/our consent to CTOS Data System Sdn Bhd, Coway’s appointed credit reporting agency to disclose my/our credit information to Coway for the purposes of determining my/our credit standing;

(IV) I/we have read Coway’s Privacy Notice at https://www.coway.com.my/privacy-notice and consent to the collection and processing of my/our personal information by Coway in accordance with Coway’s Privacy Notice;

(V) I/we have obtained the prior consent of the Second Contact Person stated above for the collection and processing of his/her personal information by Coway in accordance with Coway’s Privacy Notice
*I/we agree to receive marketing and promotional information about products/services offered by Coway and/or which Coway believes may be of interest to me/us (“Marketing Messages”) by any modes ofcommunication
* You have the right to opt out of receiving Marketing Messages by ( clicking on the " link provided in each email/SMS you might receive or ( by contacting our Toll Free Careline at 1800 888 111.
New Customer Signature*

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New Customer Signature*

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New Customer Signature (T&C page)*

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New Customer Signature (T&C page)*

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