A) Company Information

Company Name

Company Registration No

Company Registration Certificate - Form D/ Form E/ Form 8/ Form 9
File type: jpg|jpeg|png|pdf

Company Type Sole ProprietorshipPartnershipPrivate LimitedPublic Limited

Company Telephone No

Company Fax

Company Email

Company Full Address

Company Website (Optional)

Company Founding Year

Number Of Employees

Company Profile

Product Catalogue (Optional)

Geographic Service Area
Local
State(s)
Town(s)

International
Please Specify

Current and Previous Project(s)/Transaction(s) with IPM. Please list down. (Optional)
1.

2.

3.

4.

5.

B) CIDB Registration Information

Grade (Select ONE only)
G1G2G3G4G5G6G7

Category (Can select multiple)
BCEME

C) Contact Information

Name

New IC Number

Designation

Mobile No (e.g. +60129876543)

Office No. (e.g. +60381231234)

Email Address

D) Disclosure of Information

Please tick (✔) in the relevant boxes if you agree to disclose the information on our social media website and other documents for distribution.

Disclosure of Information
Company InformationCIDB Registration InformationContact Information

I Agree

I hereby acknowledge that I have read and agree to the Terms and Conditions

We pledge to fully comply with the requirements of the Personal Data Protection Act 2010 (“PDPA”). In which your personal information collected from or provided by you is processed, disclosed and safeguarded by IPM.

Kindly reenter following for verification purpose:

Name

New IC Number

I hereby certify that all the above information given are true and correct as to the best of my knowledge. Hereby I confirm and agree to give my consent to IPM that IPM may collect, record, hold or store, use and disclose my personal or company data, as provided in this application form, to the third party organisation for the business purposes.