KSM Online Application

How to Join?
Just fill out this enrollment form and pay Php100 upon card pick-up at your nearest branch. Or you can get it for FREE just by presenting your Rose Pharmacy single or accumulated receipts worth Php1,000.00 or more.

We at Rose Pharmacy, have always been committed to genuine and affordable medicines and now with KSM card, you can save even more!

EARN MORE, SAVE MORE with Rose Pharmacy KSM Card

Customer Information

First Name:

Middle Name:

Last Name:

Birthday:

Email

Civil Status:

Gender:

Street Address:

City:

Province:

Zip Code:

Landline Number

Mobile Number

Branch Where your card to be Pick-up

Date to be Pick-up

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