testing-tng - PRISTIN

Cashback Redemption Form

Full Name: Preferred Name: Email: Phone Number:

Kindly ensure your HP number is correct, as we will credit the cashback to this HP e-wallet.

Choose a age group: Gender: Birthday: Please select your birthday Postcode: Choose State: Purchase from which pharmacy?: Total Purchase Amount on Holista Products:

Pristin, Lacto-5, MOO, Narcox, Bitreen, Shartilage, Nutracare

Attachment: