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Application Type New Employer Existing Employer

Registration Type -- Please Select -- Company Registration: Registration No. (SSM No. / MyCoID, Professional Bodies, Society, Association, Co-operative Societies) Domestic Registration: Employer's Identification No. (Not registered with SSM and other agencies) Government Agency: No. PTJ Kerajaan Persekutuan atau Kerajaan Negeri

Employer Code

Name

Registration No.

Postal Address

State -- Please Select -- JOHOR KEDAH KELANTAN MELAKA NEGERI SEMBILAN PAHANG PERAK PERLIS PULAU PINANG SABAH SARAWAK SELANGOR TERENGGANU WILAYAH PERSEKUTUAN KUALA LUMPUR WILAYAH PERSEKUTUAN LABUAN WILAYAH PERSEKUTUAN PUTRAJAYA

City -- Please Select --

Postcode -- Please Select --

Owner / Representative Information

Full Name

Identification Type New Identification No. Passport No.

Identification No.

Contact No.

Email

Security Phrase

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