64TH MERDEKA SHOP & WIN CONTEST
Please fill up the form completely to fulfill the requirement to participate in Georgetown  Pharmacy & Wellings Pharmacy's 64th Merdeka Shop & Win Contest.
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Full name as per in IC *
Citizenship Status *
IC Number *
(With '-' E.g. 79XXXX-08-XX56)
Contact Number *
(With '-' E.g. 010-485XXXX)
Receipt Sales Number / Invoice Number *
For Wellings Pharmacy - Refer to Sales No./ For Georgetown Pharmacy - Refer to Invoice No.
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Receipt Purchase Amount *
For Wellings Pharmacy - Refer to Total Sales Incl.Tax / For Georgetown Pharmacy - Refer to Total Sales After Rounding
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