Full Name
NRIC No
Email Address
Contact No
Mailing Address
(Applicable for life insurance agents only)
Name of Company
Position
Name of Agency Leader
Year of Experience
Last Year Production
Last Year Recruitment
Highest Achievement MDRTOverseas TripBranch/RegionalNational Topper Others
Length of Consulting & Mentoring 1 year2 year3 year
Preferred Day of Consulting & Mentoring MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Preferred Time of Consulting & Mentoring 9am10am11am12pm1pm2pm3pm4pm5pm
Payment Mode MonthlyQuarterlyHalf-YearlyYearly
I am hereby opted to pay my consulting and mentoring fees by installments as stated above under "Payment Mode" section and agreed to pay the balance months of consulting and mentoring fees if I did not complete a minimum 1 year of consulting and mentoring period.
Preferred Language MandarinEnglishMalay
Comments/Questions
Note : Preferred day and time of consulting and mentoring is subjected to the availability of the consultant.
Richmind Consulting & Mentoring Sdn Bhd Bank Details
Bank : Maybank Account No : 511235008657 Account Name : Richmind Consulting & Mentoring Sdn. Bhd
