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Company name * |
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Business Registration No * |
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Office Address * |
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Tel No * |
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Fax No * |
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Website |
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Company's representatives for contact |
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Name of Representative |
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Gender |
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H/P No |
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Office Address |
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Tel. No. |
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Fax No. |
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2. |
E-mail Address |
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Nature of Business * |
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4. |
Product brand (please specify if any) |
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5. |
Export Countries (please specify if any) |
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Attachment |
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Please submit SSM, Form 9, Form 24 and others related to company in PDF format.
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- I hereby declare the above information is true to the best of my knowledge.
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Name of Applicant |
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Date |
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Contact No. |
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The information with * remark, will be shown in https://acci.my/, the rest will keep privacy. |
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