Sample Request
Thank you for choosing DIAPEX Premium of superior baby diapers for your little one. DIAPEX Premium especially designed to take the stress out of changing the nappy of an active baby. Fill in the details below to receive a FREE sample. We will send it to your little one right to your doorstep.
 
Personal Details
Name *  : 
My Kad *  :   eg:130101051234
Address *  : 
Town *  :  Postcode *  : 
State *  : 
Race *  :  Chinese   Indian   Malay   Others     (if any)
Mobile No. *  :   eg:012-1234567
Email Address *  : 
Baby's Place of Birth *               : 
Type of Hospital *                     :  Government   Private   
Are you currently pregnant *     :  No   Yes   
Baby's Details
Name *  : 
Gender *  :  Female   Male   
Current Diaper Brand *              : 
Current Diaper Size *                : 
Baby's Date of Birth *               :  - -   (dd-mm-yyyy)
Baby's Weight *                         :   KG
Sample Request Type *             : 
Sample Size *                            : 
 
I have read and agree with the data protection and the explanation.
       Saya telah membaca dan memahami terma-terma Notis Privasi and memberi keizinan
       kepada pemprosesan Data Peribadi saya seperti yang dinyatakan.
 
 
Terms & Conditions apply.
* Only one(1) sample pack will be sent per child per house. Repeated the address will not be entertained.
* Each sample pack contains two pieces of baby diapers.
* Repeated requests from the same household for the same child are allowed only after a waiting period of 6 months.
* Please allow up to 2 months for delivery.
* A valid MyKad number is compulsory for proceeding with sample requests.
* Sample requests are valid for Malaysian resident only.
* Sample requests with incomplete personal details will not be entertained.
* Nibong Tebal Enterprise Sdn. Bhd. reserves its right to cancel, terminate or suspend this program with or without any prior notice and reason.