Name ( Nama )
*
Phone Number ( No. Telefon )
*
Please enter a valid phone number, as we can contact you if you win the prizes.
Quantity Purchased (Kuantiti Belian)
*
2 boxes = 1 entry, based on the quantity shown on the receipt.
State ( Negeri )
*
Please Select
Selangor
Perak
Kedah
Perlis
Pulau Pinang
Kelantan
Terengganu
Pahang
Johor
Negeri Sembilan
Melaka
Kuala Lumpur
Sabah
Sarawak
Labuan
Putrajaya
Place Of Purchase ( Tempat Pembelian )
*
E.g ABC Pharmacy, MetaCare Pharmacy
Receipt Number ( Resit No.)
*
Take or Upload Photo Of Receipt ( Ambil Atau Mauk Naik Foto Resit )
Location (Hide)
Submit
Should be Empty: