Personal Particulars

Membership Category

**Associate Membership fee: RM200.00
Full Name

Rose Premo
Date of Birth (day/month/year)

December 10, 1935
Citizenship

TF
IC/Passport No

ID
Place of Issue

RG
Contact No (Home)

https://goo.gl/Qot5x1
Contact No (Mobile)

(08) 9084 9529
Email (Required)

rose_premo6@zegelardo.com
Residential Address (Required)

YA
Correspondence Address

NQ