Instruction To Apply Eclaims Membership :
1. Fill up the registration form.
2. Bank-in RM500 to our Public Bank Account :
  Account Name : OneWorks Sdn Bhd
  Account No : 3103 9522 19
3. Write down your workshop name on the bank-in slip.
4. Fax back to us with bank-in slip and registration form at 03-7989 0202.
 
  E-CLAIMS MEMBERSHIP APPLICATION   FORM
OneWorks Sdn Bhd (223528-T) M 4
No.19-1, Jalan 1/116B, Kuchai Entrepreneurs' Park, 58200 Kuala Lumpur.
Tel 60(3)7985 8590/91/92/93/96    Fax 60(3)7985 8505    Url:http://www.eclaims.com.my
     COMPANY PARTICULARS
     NameIC No.
                                          
                           
                                          
     Company NameDesignation
                                          
                           
                                          
                           
     Company NoTelephone
                              
                     
     AddressFacsimile
                                          
                     
                                          
Email
                                          
________________________
     Postal Code                    City
                                               
 
     No Of Employees           No Of PCs In Your Organization      
 
     SERVICE DETAILS: www.eclaims.com.my
  Charges
     Submission to subscribed Insurers electronically  
     * This will include: (i) Unlimited access to the case file  (ii) Unlimited supplementary claims RM 10
  
     Prepare and print repair estimate only  
     * This allow the print-out of repair estimates and with no submission. RM 10
  
     Please include RM500.00 prepayment for claims processing charges.  
     * A prepaid balance of RM50.00 have to be maintained at all times.  
  
     PAYMENT
     Payment can only be made by Crossed Cheque/Money Order/Bank Draft made Payable to: OneWorks Sdn Bhd
     Please send payment to: OneWorks Sdn Bhd, No 19, Jalan 1/116B, Kuchai Entrepreneurs' Park, 58200 Kuala Lumpur.
     Payment can also be made directly into our Public Bank Account : 3103952219. Please send a copy of the bank-in slip.
     Bank
                       
Amount
                 
     Cheque No
                          
 
     DECLARATION
     I/We represent and warrant that the above information given is true, correct and valid. OneWorks Sdn Bhd reserves the right 
     to reject this application and / or terminate the service at any time without making any refund or payment should the above 
     information is found to be false, incorrect or invalid. By using this service,I/We hereby agree to be bound by all terms and 
     conditions as stated overleaf.
          Organization/Company Stamp
     Date
               
Signature