It’s more than a club. It’s a community

Owners and drivers are welcome to join!Visit us at www.benz.me/mbtc for more details

• Get a driver’s pack when you signup• Enjoy discounts and privileges from your MBTC card• Exclusive invitation to MBTC events and activities • Entitled to join all MBTC competitions• Enjoy discounts for Mercedes-Benz merchandise and much more !

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Mercedes-BenzT R U C K E R S C L U B

*Terms and conditions apply

A. PERSONAL DETAILS

B. OWNER INFORMATION

C. DRIVER INFORMATION

D. Declaration

Name (as in NRIC/Passport)

Employer :

Vehicle(s) driven in previous 2 years

By submitting this application and subject to approval of my membership of Mercedes-Benz Malaysia, I agree to be bound by the rules andregulation of MBM herewith and hold MBM harmless in all respects arising from my actions, which are not in line with the objectives of MBM. I alsoagree that any and all actions and representations made without the express approval of the MBM and/or its elected office bearers are personalactions and representations and MBM shall not be held liable in all respects.

DisclaimerSubmission of the application form is not proof of acceptance of membership. MBM has the right to rejust any application without disclasing the reasonstherewith. Applicant will be duly notified by MBM of the status of their application through email/phone within 2 weeks of application and duly return theregistration and membership fee should your application be rejected.

Total years of driving : years years

Address :

NRIC/Passport No.

Date of Birth

Citizenship

Gender

Place of Birth

(DD-MM-YYYY)

MB Club Forum Nickname

Mr

Male

Citizen Permanent Residence

Nationality

Correspondence Address Contact Number

Company name

E-Mail Address

Mobile

Home

Office

Postcode

Malaysian Others (Please Specify)

Others (Please Specify)

Female

Marital Status Single Married

Shirt Size

Ms Mdm

Owner (fill up Section ‘B’ - Owner Information) Driver (Fill up Section ‘C’ - Driver Information)

Others

State

Town/City

Country

Office No. :

Nature of business :

Number of Mercedes-Benz Trucks currently owned :

Fax :

Email :

Actros 2460S/33

Actros 2460S/6X2

Actros 2460S/6X4

*Please Specify brand and model*Others :

Actros 3939K

Actros 3939K 6X4

Actros 3939K 6X6

Total years of driving Actros :

Driving License No. : Expiry date :