NIKKEN PHILIPPINES INC.
JMT Corporate Condominium, Suite 10B
27 ADB Avenue, Ortigas Center Pasig City, Metro Manila
Tel. No.: (632) 6370194
Fax No.: (632) 6370193
INDEPENDENT WELLNESS CONSULTANT APPLICATION AND AGREEMENT
INDEPENDENT WELLNESS CONSULTANT INFORMATION
TIN Number
Evening Phone
Daytime Phone
Mobile Phone
Fax No
Email Address
Name (Last, First, Middle)
INDEPENDENT WELLNESS CONSULTANT CO-APPLICANT INFORMATION
Co-Applicant (Last, First, Middle)
Mailing Address (No PO Box Allowed)
City
Province
Postal Code
SPONSOR INFORMATION
ID number
Mobile Phone
Daytime Phone
Email Address
Name (Last, First, Middle)
AS A NEW INDEPENDENT WELLNESS CONSULTANT OF NIKKEN PHILIPPINES, INC.,
I UNDERSTAND AND AGREE THAT:
The above-named individual/entity (herein called "Wellness Consultant") agrees to the terms set below between Nikken Philippines, Inc. (herein called "Nikken") and Wellness Consultant. The Wellness Consultant is and at all times shall remain an independent contractor and is not representative or participant or with Nikken for any purpose whatsoever. Wellness Consultant agrees to be responsible for own expenses, licenses, income tax, and VAT as stipulated by the government or other regulatory agencies of the Republic of the Philippines, except for those payments that are expressly arranged by Nikken. The Nikken marketing program (herein called "Plan") along with the Nikken manual (herein called "Manual") are hereby incorporated into and made an integral part of this agreement. Independent Wellness Consultant acknowledges being familiar with and agrees to abide by all of the terms and conditions of the Plan and Manual as currently constituted and as maybe amended from time to time by Nikken. The term of the Nikken Independent Wellness Consultant agreement is one year. Wellness Consultant who wish to continue their distributorships must apply to renew and extend their distributorship or Independent Wellness Consultant agreement by their anniversary date. Subject to acceptance by the company. The renewal must be received by Nikken in writing in accordance with the policies set forth in the Manual. Independent Wellness Consultant will not misrepresent Nikken in any manner and will make no statements, claims or warranties with respect to Nikken which are not contained in Nikken written materials. Wellness Consultant agrees to perform all of his/her obligations under this agreement in a manner consistent with all applicable laws and regulations and with the principles of good conduct and business ethics in order to protect and enhance the name of Nikken, the reputation of the product and the goodwill attached to and trade names or any trademarks in use or hereafter adopted or used by Nikken. Independent Wellness Consultant agrees to familiarize him/herself with all Nikken products are not considered and are never offered or intended as medicines or medical treatments for any disease or disorder either physical or mental. Independent Wellness Consultant is prohibited or enjoined as a condition of this agreement from participating in any diagnosis, prognosis, evaluation, treatment, description, management or remedy of any disease or physical or mental disorder. Independent Wellness Consultant understands that there are no guarantees of any earnings in the Plan and that there are no exclusive territories within the Plan. Independent Wellness Consultant understands that there are no personal purchase requirements of Nikken products at any level of the Plan beyond the initial expense for becoming a Wellness Consultant, and that the only expenses incurred by becoming an Independent Wellness Consultant is a purchase of a Sales Kit. Wellness Consultant also understands that there are no inventory requirements of Nikken products and that Wellness Consultant may terminate the Agreement at any time upon confirmation of receipt of written notice to Nikken. Independent Wellness Consultant understands and agrees that a violation of any of the terms of the Agreement, including the policies and procedures of Nikken, may result in the termination of the distributorship and all rights and privileges therein. Upon notification of cancellation or termination, Nikken agrees to repurchase any mandatory sales aids and/or product in accordance with the policies stated in the manual. Independent Wellness Consultant will not assign, sell or otherwise convey to any other person or entity any of the rights, privileges and interests of a Wellness Consultant without the prior written consent of Nikken. Wellness Consultant agrees to provide adequate follow up support, encouragement and service to all of his/her customers and downline distributors. This agreement shall be governed by the laws of the Republic of the Philippines, and appropriate court in Pasig City, Metro Manila. In entering the Tax Identification Number (TIN) above, Independent Wellness Consultant is certifying this is the true and correct TIN of the Wellness Consultant.
METHOD OF PAYMENT
Cash
Amount:
Check
Check No.:
Bank Name:
Bank Deposit
Deposit Date:
Deposit Amount:
Bank Deposited To:
Ref. No.:
VISA
Mastercard
JCB/RCBC Card
Unicard
Diners
BPI Express
Credit Card No.:
Expiry Date:
Total Amount Due:
Cardholder Name:
Cardholder Signature:
Date:
ITEM
PRODUCT
PV
PRICE
9200
5K Business Kit with Magsteps SM
125
Php 5,500.00
9201
5K Business Kit with Magsteps MD
125
Php 5,500.00
9210
5K Business Kit with Magstrides SM
125
Php 5,500.00
9211
5K Business Kit with Magstrides MD
125
Php 5,500.00
9212
5K Business Kit with Magboy
125
Php 5,500.00
9231
1K Business Kit with Liver Support
22
Php 995.00
9230
1K Business Kit with 20pcs Magbiens
22
Php 995.00
Applicant Signature:
Co-Applicant Signature:
Form PH9050 Rev. 11/05
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