Agent Registration
Login ID* Password*
Introducer Confirm Password*

Company Details
Billing Address*
Bus. Reg. No/IC No* Postcode*
Type Of Business* Country*
Contact No.1* State*
Contact No.2 City*
Fax No.

Individual Application Details
Applicant Name* IC No. *
Mobile Phone No.* Position
Gender Race
Nationality * Email *

Person Incharge Details
P. Incharge Name* E-mail Address*
Contact No.* Mobile Phone No
Type* Bank*
Prepaid Amount* (Minimum deposit RM 100)
Click to see Bank Accounts
Payment Slip*
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I have read and agree to the Agent's Membership Terms & Condition.