UPP 1
Lembaga Pembangunan
Industri Pembinaan Malaysia
CONSTRUCTION INDUSTRY DEVELOPMENT BOARD
http:/www.cidb.gov.my
RENEWAL
Please where applicable. For renewal, information for A, F & G are necessary
to fill-up. Please enclose the certified documents as instructed.
A. APPLICANT'S INFORMATION
The Construction Personnel Registration Programme is based to Pekeliling
Program Kad Hijau CIDB Bil.1/2000 dan Bil.1/2001.
General instruction:
- This Form is to be read together with Construction Personnel Registration
Requirements & Procedures.
Date of
birth:
Wong Ming Ming
Passport Size Photo
with blue background
01/01/1990
(With capital letter as in i.c/passport)
New i.c.
no:
PHOTO MUST BE SHARP
& CLEAN
CIDB Registration Card No:
(Enclose copy of certified i.c)
Full name:
Please paste one recent
i.c. size colour photograph
with glue. Do not use
stapler/cut the photo.
CONSTRUCTION PERSONNEL
REGISTRATION FORM
Tingkat 10, Menara Dato' Onn,, Pusat Dagangan Dunia Putra,
No 45, Jalan Tun Ismail, 50480 Kuala Lumpur
Tel: 03-4047 7000 Fax No : 03-4047 7070
NEW REGISTRATION
Pin.1/2014
PHOTO
FORM IS GIVEN
FOR FREE
Old i.c.
no:
900101-13-1234
Malaysian
Nationality:
EXTRA INFORMATIONS TO BE FILLED-UP BY FOREIGN WORKER
Passport
no:
Work permit
expiry date:
Race:
Chinese
Sex:
(Enclose copy of passport with valid work permit certified by employer as appear on work permit)
Male
Correspondence address:
Religion:
Female
Marital status:
Christian
Single
Married
Divorcee/Widow/Widower
Permanent address if different:
No. 1, Jalan Tabuan
Kuching, Sarawak
Mobile 012 123 4567
93350
Postcode
Tel. no.:
Postcode
tel. no.:
B. ACADEMIC/SKILL QUALIFICATION
SRP/LCE
/PMR
Primary
SPM
/MCE
Others (please specify)
(Enclose copy of Technical Cerificate (marked **) if any)
Polytechnic**
Diploma**
SKM**/
Degree**
SPVM**
Master**
Degree
C. INFORMATION OF OCCUPATION
General
Worker
Construction
Worker
Income in daily/monthly:
daily
monthly
Skilled
Construction
Worker
Doctor of **
Phylosophy
Others (please specify)
Construction
Site
Supervisor
Assistant
Construction
Manager
Amount of salary in RM:
Daily
<29
Monthly
<499
30-39
500-749
Construction
Site Manager
Construction
Trainee
40-49
750-999
50-59
1000-1499
Administrative
Personnel
60-79
1500-1999
Student
80-99
2000-2499
100-1119
2500-2999
120-139
3000-3999
140 or
4000 more
Field of skills & years of experience (please refer list of trades in the form)
1.
Years
2.
Years
3.
Years
4.
Years
5.
Years
6.
Years
D. EMPLOYER INFORMATION
Company name and address:
Contractor registration no. with CIDB:
Please jif self employed
Swinburne University of Technology
Jalan Simpang Tiga
Kuching, Sarawak
93350
Postcode
E. BENEFICIARY INFORMATION
Sex:
Wong Teck Siong
I.c. no./
Birth cert. 580831-13-1233
Male
Relationship:
Tel. no:
Female
/passport (if available)
Father
012 111 2345
Fax
no:
082-416353
F. APPLICANT'S DECLARATION
(Fill-up if applicant ages between 16 and 65 years old)
Name:
Tel
no:
Mobile
tel no:
G. CERTIFICATION
(Certification can be made by officers as stated in
the registration procedure. For foreign worker,
certification can only be done by employer as
appeared in the work permit).
I hereby certify that all the informations given
and copy/ies of document/s enclosed with this
form are right and true.
Application/Registration will be automatically
deemed nullified for any false information and
action including lawsuit can be taken.
I hereby certiffy that informations given are true.
To be certified and
CERTIFICATION
stamped
by the SIC
Sign and date
Permanent address if different than applicant's address:
082-260813
Signature & Date
Signature & Date
Wong Ming Ming
Postcode
RM50
Foreign worker
with one year or less
work permit
RM25
RM50
Payment can be made by
money order or bank draft
made payable to CIDB
Malaysia. Cash payment can
only be accepted for
submission at CIDB counter
RENEWAL FEE
Local worker
ages between
16 and 70 years
Local worker
ages above
70 years
Foreign worker
with one year or less
work permit
Foreign worker with
more than one year
work permit
Tarikh terima:
RM50
RM50
RM70
RM100
(2 YEARS)
(3 YEARS)
(5 YEARS)
RM50
(5 YEARS)
RM25
RM50
(AS IN
WORK
PERMIT)
(MAXIMUM
OF
2 YEARS)
...................................
Bayaran: RM
................................
No. Resit: ....................................................................................
Borang Bermasalah
OFFICE USE
REGISTRATION FEE
Local worker
Foreign worker with
more than one year
work permit
Name
Name
Pengesyoran Kategori & Tred
Bayaran kurang/tiada
Maklumat pewaris tidak diisi
GW
Pembaharuan
Salinan k.p. tiada
Salinan sijil ....................................
tidak disertakan
CW
Tukar Kategori
SW
Tukar Tred
Salinan pasport/permit tiada
Tiada pengakuan pemohon
SS
KIV
Permit kerja syarikat lain
Tiada pengesahan majikan
Permit kerja bukan binaan
Lain-lain:
AM
MG
Gambar tiada/tidak sesuai
LT
AD
Semakan Ke2:
.................................................................
Please photocopy your IC, SPM result and student ID, and bring them with your original one to SIC for
certification and stamp. Attach the certified copies with this form for submission.
For foreigners, please photocopy your passport photo page and visa page instead of IC.
