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DP11 Form

This document contains an application form for an expatriate pass from the Malaysian Immigration Department. The form requests information about the applicant such as name, nationality, passport details, and position. It also requires details about the applicant's employer such as company name, address, registration number, contact person, and type of pass being applied for. Finally, the applicant and the authorized representative from the employer must sign and date the form, certifying that the information provided is accurate.

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Thinzar Najma
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© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
9K views1 page

DP11 Form

This document contains an application form for an expatriate pass from the Malaysian Immigration Department. The form requests information about the applicant such as name, nationality, passport details, and position. It also requires details about the applicant's employer such as company name, address, registration number, contact person, and type of pass being applied for. Finally, the applicant and the authorized representative from the employer must sign and date the form, certifying that the information provided is accurate.

Uploaded by

Thinzar Najma
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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JABATAN IMIGRESEN MALAYSIA IMMIGRATION DEPARTMENT OF MALAYSIA MAKLUMAT PEGAWAI DAGANG / EXPATRIATE INFORMATION ( DP11)

Tandakan (X) Dalam Petak Berkenaan / Mark (X) in Approriate Box

DP11
Jenis Permohonan Type Of Application Baru / New Lanjutan / Extension

A. MAKLUMAT SYARIKAT ATAU MAJIKAN / PARTICULARS OF COMPANY OR EMPLOYER 1. No Pendaftaran Syarikat / Registration of Company No
2. Nama Syarikat / Majikan / Name Of Company / Employer

3. Alamat Syarikat / Majikan / Address Of Company / Employer:

Agensi Pelulus / Approving Agency JKPD MIDA MDeC JPA SC KHEDN BNM

Poskod / Postcode 4. No Telefon / Telephone No. : 5. No Faks/ Fax No. : 6. E-mail :


7. Pegawai Perhubungan Syarikat / Majikan / Contact Person from Company / Employer :

Bandar / City
Jenis Pas / Type Of Pass

Pas Penggagian / Employment Pass Pas Lawatan ( Kerja Sementara ) / Visit Pass (Temporary Employment)

Lain-lain / Others

8. Jawatan / Position :

VDR Tempat / Place : ______________________

B. MAKLUMAT PEGAWAI DAGANG / PARTICULARS OF EXPATRIATE


JP Visa

1. Warganegara / Nationality 2. Nombor Pasport / Passport No. 3. Nama Penuh / Full Name 4.Jantina / Gender : 5. Tarikh Lahir / Date of Birth 6. Tarikh Tamat Pasport / Passport Expiry Date 7. Tempat Dikeluarkan / Place of Issue 8. Tarikh Dikeluarkan / Date Of Issue 9. No Pasport Lama / Old Passport No.

: : : Lelaki / Male : : : : : : / / / / / / Perempuan / Female / /

Pas Khas / Special Pass Cooling Off Period Pinda Tempoh Sahlaku Pas / Amendment To Validity Of The Pass Pindah Pas / Transfer Endorsment Lain-lain Sila Nyatakan Others Please State __________________________ ___________________________

10. Tarikh Masuk Malaysia / Date Of Entry To Malaysia


11. Alamat di Malaysia / Address in Malaysia :

Tampal Sekeping Gambar Pegawai Dagang

Poskod / Postcode 12. Jawatan / Position :

Bandar / City

Paste A Photo Of Expatriate (3.5cm X 5.0 cm)

13. Gaji Sebulan / Salary permonth : RM 14.Tempoh Pas Dipohon / Duration Of Pass Applied 15. No Cukai Pendapatan / Income Tax No. : C. AKUAN / DECLARATION
Saya memperakui bahawa maklumat / kenyataan di atas adalah benar : I hereby declare that the particular / information furnished above is true : Tandatangan majikan/ Signature of Employer Nama Penuh / Name No. KPT / No. Paspot / I/C. No. / Passport No. Jawatan / Position Tarikh / Date
Bahagian Pas Penggajian

Bulan / Month

: : : : :

Cop Syarikat Companys Stamp

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