UPP 1

Lembaga Pembangunan FORM IS GIVEN PHOTO

Industri Pembinaan Malaysia FOR FREE
CONSTRUCTION INDUSTRY DEVELOPMENT BOARD Pin.1/2014 Please paste one recent
Tingkat 10, Menara Dato' Onn,, Pusat Dagangan Dunia Putra,
No 45, Jalan Tun Ismail, 50480 Kuala Lumpur
CONSTRUCTION PERSONNEL i.c. size colour photograph
Tel: 03-4047 7000 Fax No : 03-4047 7070
http:/www.cidb.gov.my REGISTRATION FORM with glue. Do not use
The Construction Personnel Registration Programme is based to Pekeliling stapler/cut the photo.
Program Kad Hijau CIDB Bil.1/2000 dan Bil.1/2001.
NEW REGISTRATION RENEWAL General instruction: PHOTO MUST BE SHARP
Please where applicable. For renewal, information for A, F & G are necessary - This Form is to be read together with Construction Personnel Registration
& CLEAN
to fill-up. Please enclose the certified documents as instructed. Requirements & Procedures.

A. APPLICANT'S INFORMATION CIDB Registration Card No:

(Enclose copy of certified i.c)
Date of
Full name:
birth:
(With capital letter as in i.c/passport)
New i.c. Old i.c.
Nationality:
no: no:
EXTRA INFORMATIONS TO BE FILLED-UP BY FOREIGN WORKER
Passport Work permit
Race: Religion:
no: expiry date:

(Enclose copy of passport with valid work permit certified by employer as appear on work permit) Sex: Male Female Marital status: Single Married Divorcee/Widow/Widower

Correspondence address: Permanent address if different:

Postcode Postcode

Mobile
Tel. no.:
tel. no.:
B. ACADEMIC/SKILL QUALIFICATION (Enclose copy of Technical Cerificate (marked **) if any) Others (please specify)
Primary SRP/LCE SPM SKM**/ Polytechnic** Diploma** Degree** Master** Doctor of **
/PMR /MCE SPVM** Degree Phylosophy
C. INFORMATION OF OCCUPATION Others (please specify)
General Construction Skilled Construction Assistant Construction Construction Administrative
Worker Worker Construction Site Construction Site Manager Trainee Personnel
Worker Supervisor Manager
Income in daily/monthly: Amount of salary in RM:
Daily <29 30-39 40-49 50-59 60-79 80-99 100-1119 120-139 140 or
daily monthly Monthly <499 500-749 750-999 1000-1499 1500-1999 2000-2499 2500-2999 3000-3999 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 Contractor registration no. with CIDB:

Company name and address: Please jif self employed
-
Tel Fax
no: no:
Mobile
Postcode tel no:

E. BENEFICIARY INFORMATION F. APPLICANT'S DECLARATION G. CERTIFICATION

(Fill-up if applicant ages between 16 and 65 years old) I hereby certify that all the informations given (Certification can be made by officers as stated in
Name: and copy/ies of document/s enclosed with this the registration procedure. For foreign worker,
form are right and true. certification can only be done by employer as
I.c. no./ appeared in the work permit).
Sex:
Birth cert. Application/Registration will be automatically
Male Female /passport (if available) deemed nullified for any false information and I hereby certiffy that informations given are true.
Relationship: action including lawsuit can be taken.
Tel. no:

Permanent address if different than applicant's address: CERTIFICATION

Signature & Date Signature & Date

Postcode Name Name

REGISTRATION FEE RENEWAL FEE Tarikh terima: ................................... Bayaran: RM ................................ No. Resit: ....................................................................................
Local worker RM50 RM50 (2 YEARS) Borang Bermasalah Pengesyoran Kategori & Tred
Local worker
ages between
RM50
RM70 (3 YEARS)
Foreign worker
with one year or less
work permit
RM25 16 and 70 years
RM100 (5 YEARS)
Bayaran kurang/tiada Maklumat pewaris tidak diisi GW Pembaharuan

Salinan sijil .................................... CW Tukar Kategori

OFFICE USE

Salinan k.p. tiada

Foreign worker with Local worker tidak disertakan
more than one year RM50 ages above RM50 (5 YEARS) SW Tukar Tred
work permit 70 years Salinan pasport/permit tiada Tiada pengakuan pemohon KIV
SS
Payment can be made by Foreign worker (AS IN AM
money order or bank draft with one year or less RM25 WORK Permit kerja syarikat lain Tiada pengesahan majikan

made payable to CIDB work permit PERMIT) MG

Malaysia. Cash payment can Foreign worker with Permit kerja bukan binaan Lain-lain:
(MAXIMUM LT
only be accepted for more than one year
work permit
RM50 OF AD
submission at CIDB counter 2 YEARS) Gambar tiada/tidak sesuai
.................................................................
Semakan Ke2: