Father Day 2021 Photo Contest Form

* Cocoro Life Login Mobile Number :
* Full Name :	Please key-in Full Name
* NRIC/Passport Number :	Please key-in NRIC/Passport Number
* Email :	Please key-in Email
* Delivery Address Line (1) :	Please key-in Address (1)
Delivery Address Line (2) :
* InsurePostcode :	Please key-in InsurePostcode
* Town / InsureCity :	Please key-in Town / InsureCity
* State :	Please select State
Sample photo shooting CLICK HERE
* Upload Photo :	(File must be either .gif or .jpg or .png or .pdf and less than 10 MB)

* Security Code (as shown in the image):



With the enforcement of the Personal Data Protection Act 2010("PDPA") since November 2013, we, Cocoro Life (Malaysia) Sdn. Bhd in Malaysia wish to inform you that we are committed to the protection of our customers' and business partners' personal information. Please visit https://cocorolife.my/pdpa/ to view our Privacy Notice. Unless you have otherwise notified us in writing, we will presume that you have read and agree consented to our processing of your personal data as set out in the Privacy Notice.