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*Name ............................... *姓名

*New/Old IC Number........ *新/旧身份证号码

*Mobile Number ............... *手机号码

House Contact Number ..住家电话号码

Office Contact Number ...办公室电话号码

Email................................ 电子邮件地址

Remarks........................... 备注

Enter the verification code 请输入验证代号

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*indicates a required field

*表示必填栏目

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Disclaimer on Online Data Submission

Please take note that the submission of your personal data is for the purpose of keeping you informed and connected with KOJADI. We will endeavor to take all reasonable steps to protect the personal information you may transmit to us and strive to ensure the security, integrity and privacy of personal information submitted by you. However, no data transmission over the Internet can be guaranteed to be totally secure. KOJADI assumes no liability for any damage or loss resulting directly or indirectly from the submission of your personal date via the internet.

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关于在线提交资料的免责声明

敬请注意，您提交您的个人资料的目的是保持您与自立合作社之间的联系。 本社将致力采取一切合理步骤 保障您传达给本社的个人资料， 以确保您所传达的个人资料的安全、完整性及私隐。 然而通过互联网传送的信息不能保证完全安全。 如果您因为通过互联网传送资料而直接或间接蒙受任何损害或损失， 本社一律不承担任何法律责任。

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