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Order Form

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*Please ensure that you fill in all of the required details.
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Personal Details

*Country code (e.g. +673) not required

Product Details

Appointment location the patient go to.
Appointment location the patient go to.
Appointment location the patient go to.
Appointment location the patient go to.

No. 69B, Jeti 4, Kampong Bolkiah B, BK1325, Negara Brunei Darussalam​

For China, our warehouse in China are relocated to the new address as stated below:

(DCN/GBS/Customer Name/Phone Number)
No 21, Yi’an West Road,
Fenggang Town, Dongguan City,
Guangdong Province, China
For Malaysia, our warehouse in Malaysia are relocated to the new address as stated below:

No. 23, Jalan Mahligai 5B/KU2,
Bandar Bukit Raja,
41050 Klang,
Selangor Darul Ehsan, Malaysia.
Please enter your Tracking Number provided by the E-commerce Platform.
For example: Shopee Malaysia
Nature of the product. For example: Cotton T-Shirt
Please select the currency of total value of your parcel.

Item Details

Enter numbers only.
No currency required to enter (E.g. RM, BND)

Please enter the item price of your parcel.

Estimated Delivery Date

*For any orders above 3kg, there will be additional charges of $1 per kg.

Receiver Information

Limbang Address:

Customer name: (name/Gobeli)
Cust. Phone Number:
Taman Desa Pabahanan Lot 184, Sarawak, Limbang, 98700
Please enter your Tracking Number provided by the E-commerce Platform.
For example: Shopee Malaysia

Item Details

Enter numbers only.
No currency required to enter (E.g. RM)

Max file size 10MB.
Uploading...
fileuploaded.jpg
Upload failed. Max size for files is 10 MB.
Please enter the item price of your parcel.

Charges Details

Notes:
  • Paying patient is only applicable to green IC holders.
  • Paying patient will be charged 3% or $2 surcharge (whichever is higher).
  • Maximum of $100 for payment on behalf.
Notes:
  • Paying patient will be charged 3% or $2 surcharge (whichever is higher).
  • Maximum of $300 for payment on behalf.
  • Patient can also choose to pay directly to JPMC.
For online payments, kindly make payment to the account number below and provide us the payment slip through WhatsApp +6732332065.
- Go Rush BIBD via bill payment
- Go Rush Express via Baiduri : 02-00-116-484129
For online payments, kindly make payment to the account number below and provide us the payment slip through WhatsApp +6738929772.
- Go Beli via BIBD : 00-001-01-0069391

The order is not submitted yet.
Please click "Agree & Submit" after confirming your details and agreeing to the terms and conditions below.
A tracking number will be sent once the order is submitted.

The tracking number and notification updates on the order status will only be provided if the user have:
1) Provided their correct active phone number
2) Installed WhatsApp
3) Updated WhatsApp to the latest version

The order will only be processed during working hours.

Order Summary

Personal Details

Full Name:
House / Unit No:
E-mail:
Phone Number:
Additional Phone Number:

Product Details

Product Type:
Patient's Number:
Patient's Date of Birth:
IC-Number / Passport:
Health Centre:
Parcel Tracking Number:
Go Rush Receiving Country:
Shipment Method:
E-Commerce Name:
Commodities:
Currency:
Weight (KG):
Permit Application?:
Does your item contains one of the following?:
Total Price:
Bill to:
Pickup or Delivery?:
Pick-Up Date:
Pick-Up Address:
Product Description:
Product Type:
Product Weight:
Receiver Information
Full Name:
House / Unit No:
E-mail:
Phone Number:
Original Tracking Number:
Courier:
Item Description:
Quantity:
Total Amount (RM):

Charges Details

Delivery Type:
Delivery Duration:
Amount to be paid:
Paying Patient:
Payment Method:
Remarks:

I acknowledge that all the information provided above is true and correct.
I have read and agree to the Terms and Condition.

Terms and Condition
Thank you!
We have received your request order.
Your tracking number will be
Tracking number
Order submitted on
Submitted Date
For online payments, kindly make payment to the account number below and provide us the payment slip through WhatsApp +6732332065.

- Go Rush BIBD via bill payment
- Go Rush Express via Baiduri : 02-00-116-484129
For online payments, kindly make payment to the account number below and provide us the payment slip through WhatsApp +6738929772.

- Go Beli via BIBD : 00-001-01-0069391

Please record / take screenshot of the details above provided for your reference.
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Contact us directly through:
Chat +673 233 2065
Call +673 235 3259
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