Beruflich Dokumente
Kultur Dokumente
UPP 1
Pin.2/2008
PHOTO Please paste one recent i.c. size colour photograph with glue. Do not use stapler/cut the photo. PHOTO MUST BE SHARP & CLEAN
http:/www.cidb.gov.my
NEW REGISTRATION
RENEWAL
Please where applicable. For renewal, information for A, F & G are necessary to fill-up. Please enclose the certified documents as instructed.
A. APPLICANT'S INFORMATION
(Enclose copy of certified i.c) Full name: (With capital letter as in i.c/passport) New i.c. no:
Nationality:
(Enclose copy of passport with valid work permit certified by employer as appear on work permit) Correspondence address:
Postcode Tel. no.: Primary SRP/LCE /PMR Construction Worker Mobile tel. no.: SPM /MCE Skilled Construction Worker
Postcode
(Enclose copy of Technical Cerificate (marked **) if any) Polytechnic** Diploma** SKM**/ Degree** SPVM** Construction Site Supervisor Assistant Construction Manager 30-39 500-749 Construction Site Manager Construction Trainee
Others (please specify) Master** Degree Administrative Personnel Doctor of ** Phylosophy Others (please specify)
40-49 750-999
50-59 1000-1499
60-79 1500-1999
80-99 2000-2499
100-1119 2500-2999
120-139 3000-3999
Field of skills & years of experience (please refer list of trades in the form) 1. 4. Years Years Please jif self employed 2. 5. Years Years Contractor registration no. with CIDB: 3. 6. Years Years
D. EMPLOYER INFORMATION
Company name and address:
Postcode
E. BENEFICIARY INFORMATION
(Fill-up if applicant ages between 16 and 65 years old) Name: Sex: Male Relationship: Tel. no: Permanent address if different than applicant's address: Female I.c. no./ Birth cert. /passport (if available)
F. APPLICANT'S DECLARATION
I hereby certify that all the informations given and copy/ies of document/s enclosed with this form are right and true. Application/Registration will be automatically deemed nullified for any false information and action including lawsuit can be taken.
G. CERTIFICATION
(Certification can be made by officers as stated in the registration procedure. For foreign worker, certification can only be done by employer as appeared in the work permit). I hereby certiffy that informations given are true.
CERTIFICATION
Signature & Date Signature & Date
Postcode
Name
Name
REGISTRATION FEE
Local worker Foreign worker with one year or less work permit Foreign worker with more than one year work permit
RENEWAL FEE
Local worker ages between 16 and 65 years Local worker ages above 65 years Foreign worker with one year or less work permit Foreign worker with more than one year work permit
Tarikh terima:
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Bayaran: RM
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Borang Bermasalah
Bayaran kurang/tiada Maklumat pewaris tidak diisi Salinan sijil .................................... tidak disertakan Tiada pengakuan pemohon Tiada pengesahan majikan
OFFICE USE
Salinan k.p. tiada Salinan pasport/permit tiada Permit kerja syarikat lain Permit kerja bukan binaan Gambar tiada/tidak sesuai
Payment can be made by money order or bank draft made payable to CIDB Malaysia. Cash payment can only be accepted for submission at CIDB counter
Lain-lain:
LT AD
Semakan Ke2:
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