Product Purchase Form – Heirs Forms

Title

If Others specify

First Name

Last Name

Gender

Date of Birth

Email Address

Mobile Number

Physical Address

Choose the Purchased Distributor

Input Device Serial Number

Beneficiary’s First and Last Name (optional)

Beneficiary’s Mobile Number (optional)

Beneficiary’s Email Address (optional)

Valid ID Card (International Passport, Driver’s license, Voter’s Card, or National ID Card)

Proof of Address (Utility Bill, Bank Statement, Rental Agreement etc.)

Photographed document of items to be insured and their cost side by side

AMAL TECH PRODUCTS PURCHASE FORM