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Registration Form Company Name* Company Address* State* Select Value Johor Kedah Kelantan Kuala Lumpur Melaka Negeri Sembilan Pahang Perak Perlis Pulau Pinang Putrajaya Sabah Sarawak Selangor Terengganu Wilayah Persekutuan KL Wilayah Persekutuan Labuan Wilayah Persekutuan Putrajaya Email* Telephone No.* Select Value 01 02 03 04 05 06 07 08 09 010 012 013 014 016 017 018 019 Fax No.* Select Value 01 02 03 04 05 06 07 08 09 Type of Industry* Select Value Padi Factory Timber & Wood Factory Non-metal Minerals Quarry Metal Manufacturing Petroleum Refining Plastics Cement Metal Fabrication Electric & Electronics Chemical Industry Vehicles Leather Cooking Oil Refining Machinery Rubber Based Paper Textiles Metal Finishing & Electroplating Food & Beverages Animal Feed Water Treament Plant - IWK Water Treatment Plant Power Generation Plant Hotel Printing Medicines Workshop Iron & Steel Factory Others Category of Industry * Select Value GOVERNMENT AGENCY SMI GLC MNC OTHERS Workers No. Select Value < 10 Workers 10 - 49 Workers 50 - 100 Workers > 100 Workers Representative Name* Select Value Miss Mr. Mrs. Dato' Datin Tan Sri Representative Position* Establish Since Company Registration No.* Company Nett Annual Income (RM) Select Value < RM 100,000 RM 100,001 - RM 200,000 RM 200,001 - RM 300,000 RM 300.001- RM 400,000 RM 400,001- RM 500,000 > RM 500,000

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