Close
HOME
ABOUT US
SERVICES
CONTACT US
GO RUSH FEEDBACK
PHARMACY REGISTRATION
Menu
HOME
ABOUT US
SERVICES
CONTACT US
GO RUSH FEEDBACK
PHARMACY REGISTRATION
Step 1 of 3
33%
PERSONAL DETAILS // INFORMASI PERIBADI
Registration for infant (Below 1 year old)? // Pendaftaran untuk kanak-kanak (dibawah 1 tahun)?
*
YES // YA
NO // TIDAK
Full Name // Nama Penuh
*
First
Last
Age // Umur (Months / Bulan)
*
Age // Umur
*
Date of Birth // Tarikh Lahir
*
Day//Hari
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month//Bulan
1
2
3
4
5
6
7
8
9
10
11
12
Year//Tahun
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Gender // Jantina
*
Male // Lelaki
Female // Perempuan
IC Number // Kad Pengenalan
*
BruHIMS number
*
Place of stay // Tempat tinggal
*
Full Address // Alamat Penuh
City // Bandar
Postcode // Poskod
District // Daerah
*
Brunei - Muara
Tutong
Kuala Belait
Temburong
Mobile Number // Nombor Telefon
*
House number // Nombor Telefon Rumah (optional)
E-mail // E-mel (optional - untuk menerima notification)
PAYMENT METHODS // KAEDAH PEMBAYARAN
Payment method // Kaedah Pembayaran
*
Cash over Counter // Pembayaran tunai di kaunter RIPAS
Cash on Delivery // Pembayaran tunai semasa penghantaran
Bank Transfer
Delivery Method // Kaedah penghantaran
*
Standard
Express
Bank's Name // Name Bank
*
Bank's Account Number // Nombor Akaun Bank (optional)
REPRESENTATIVE DETAILS // INFORMASI WAKIL
Full Name // Nama Penuh
*
First
Last
Relationship with Applicant // Hubungan dengan pemohon
*
IC Number // No. Kad Pengenalan
*
Full Name // Nama Penuh (optional)
First
Last
Relationship with Applicant // Hubungan dengan pemohon (optional)
IC Number // No. Kad Pengenalan (optional)
Need Help?
Chat with us
Start a Conversation
Hi! Click one of our member below to chat on
Whatsapp
The team typically replies in a few minutes.
Pharmacy Delivery
Pharmacy Delivery Team
I will be back soon
Go Rush Delivery
Go Rush Team
I will be back soon
