Agent Registration
Login ID* Password*
Introducer Confirm Password*

Company Details
Company/Applicant
Name*		 Billing Address*
Bus. Reg. No/IC No* Postcode*
Type Of Business* Country*
Contact No.1* State*
Contact No.2 City*
Fax No.
New Registration No.*
Tax Identification No. (TIN)*
SST 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*
Please upload only jpg, png, or pdf files. File size must be 1MB or below

I have read and agree to the Agent's Membership Terms & Condition.