Contest Period: 1 March – 30 Apr 2024 Name* First Last IC Number* Mobile Number* This should be the same mobile number that is registered in your TnG eWalletEmail* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Store Name & Location (e.g. Jaya Grocer Ampang)*JAYA 33 SUPERMARKET (M) SDN BHDJAYA GROCER 1 UTAMAJAYA GROCER AMPANGJAYA GROCER ARA DAMANSARAJAYA GROCER AUSTIN HEIGHTSJAYA GROCER BANGIJAYA GROCER BUKIT JELUTONGJAYA GROCER CENTRE POINTJAYA GROCER COURTYARDJAYA GROCER CYBERJAYAJAYA GROCER DA MENJAYA GROCER DC MALLJAYA GROCER ECO ARRDENCEJAYA GROCER ECO GRANDEURJAYA GROCER ECO MAJESTICJAYA GROCER EMPORIS KOTA DAMANSARAJAYA GROCER GAMUDA QUAYSIDEJAYA GROCER GLO DAMANSARAJAYA GROCER INTERMARKJAYA GROCER IPOH PARADEJAYA GROCER ISKANDAR JOHORJAYA GROCER JAYA SHOPPINGJAYA GROCER JOHOR RNFJAYA GROCER KL EASTJAYA GROCER KLIA2JAYA GROCER KUANTAN CITYJAYA GROCER LALAPORT BBCCJAYA GROCER M/NILAIJAYA GROCER MONT KIARAJAYA GROCER MONT KIARA 163JAYA GROCER PEARL SHOPPINGJAYA GROCER PENANG GURNEY PARAGONJAYA GROCER RIO PUCHONGJAYA GROCER SAUJANA UTAMAJAYA GROCER SIERRAMASJAYA GROCER SUBANG JAYAJAYA GROCER SUNWAY CARNIVAL MALLJAYA GROCER SUNWAY GEOJAYA GROCER THE GARDENSJAYA GROCER TROPICANAJAYA GROCER TROPICSJAYA GROCER UPTOWNJAYA GROCER USJ 21OtherWhich Jaya Grocer did you buy from? Please select from the list below.Receipt Number (Last 4 Digits)*Snap and upload a complete and clear photo of the receipt(Retain the original receipt for validation purpose) Drop files here or Select files Max. file size: 1 MB. By submitting this form, you agree to the terms in our Privacy Policy. For the full terms and conditions, please visit Terms & Conditions.NameThis field is for validation purposes and should be left unchanged.
