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Jimla Requesting Form

Full Name ^*

Phone ^*

Tin Number ^*

Business License ^*

Please Select Your License File.
Files must be PDF Or Image. Maximum size 5 MB.

VAT Registration ^*

Please Select Your VAT File.
Files must be PDF Or Image. Maximum size 5 MB.

Address ^*

Product ^*

Product Brand ^*

Product Size ^*

Amount ^*

Note: Amount must be dozen of product you selected.