GREENTOWN WASTE MANAGEMENT SDN. BHD (1397363-P) 1-23-5 Menara Bangkok Bank, Berjaya Central Park, Jalan Ampang, 50450 Kuala Lumpur Phone: +603 78904395 Fax: +603 21816027 Email: [email protected] Website: http://www.dumpbin.my Dump Bin SERVICE PROVIDER APPLICATION FORM

Company Name: Account No: Document Required Submitted Remark Registration Of Companies (ROC) (A) For Companies : I) Form 9,13(if applicable) & M&A II) Latest From 24,44,49 and List of shareholders (B) For Business (Sole-proprietor/ Partnership) I) Business Registration Form(Form D) II) Partner’s Information Form(Form B)

Contact Person Company Profile

Director’s I.C Photocopy

Bank Account Number

Lorry Plate Number :

RORO Bin Size: Small (2ft / 2.5ft / 3ft) Large (3.5ft / 4ft) Giant (5ft / 6ft) Cover Region: JOHOR PAHANG SELANGOR NEGERI SEMBILAN KEDAH PENANG SABAH KELANTAN PERAK SARAWAK LABUAN PERLIS TERENGGANU MELAKA PUTRAJAYA KUALA LUMPUR

Prepare by :(Service Provider) Acknowledge by: (Sales Team) Received by: (HQ)

Name: Name: Name:

PIC Contact: Date: Date:

Form 001 Dump Bin STATE CITY LIST

Perak Ayer Tawar Selekoh Bagan Datoh Seri Manjong Bagan Serai Seri Manjung Bandar Seri Iskandar Simpang Batu Gajah Simpang Ampat Semanggol Batu Kurau Si�awan Behrang Stesen Slim River Bidor Sungai Siput Bota Sungai Sumun Bruas Sungkai Changkat Jering Taiping Changkat Keruing Tanjong Malim Chemor Tanjong Piandang Chenderiang Tanjong Rambutan Chenderong Balai Tanjong Tualang Chikus Tapah Enggor Tapah Road Gerik Teluk Intan Gopeng Temoh Hutan Melintang TLDM Lumut Intan Trolak Ipoh Trong Jeram Tronoh Kampar Ulu Bernam Kampung Gajah Ulu Kinta Kampung Kepayang Kamun�ng Kuala Kangsar Kuala Kurau Kuala Sepetang Lambor Kanan Langkap Lenggong Lumut Malim Nawar Manong Matang Padang Rengas Pangkor Pantai Remis Parit Parit Buntar Pengkalan Hulu Pusing Rantau Panjang Sauk Selama