FORM IS GIVENFOR FREE

Lembaga PembangunanIndustri Pembinaan MalaysiaCONSTRUCTION INDUSTRY DEVELOPMENT BOARD

Ibu Pejabat CIDB, Tingkat 7, Grand Seasons Avenue, No 72, Jalan Pahang, 53000 Kuala Lumpur

Tel 03 2617 0200, Faks: 03 4043 0801

http:/www.cidb.gov.my

PHOTO

Please paste one recent i.c. size colour photograph

with glue. Do not use stapler/cut the photo.

PHOTO MUST BE SHARP & CLEAN

CONSTRUCTION PERSONNEL REGISTRATION FORM

Correspondence address: Permanent address if different:

EXTRA INFORMATIONS TO BE FILLED-UP BY FOREIGN WORKER

(Enclose copy of passport with valid work permit certified by employer as appear on work permit)

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.

PrimaryOthers (please specify)

General Worker

DailyMonthly

Years

Company name and address:

Tel no:

Fax no:

I.c. no./Birth cert./passport (if available)

Tel. no:

Permanent address if different than applicant's address:

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.

Years Years

Years

SRP/LCE/PMR

SPM/MCE

SKM**/SPVM**

Polytechnic** Diploma** Degree**

Construction Worker

Skilled Construction Worker

Construction Site Supervisor

Construction Site Manager

Administrative Personnel

<29<499

30-39500-749

40-49750-999

50-591000-1499

60-791500-1999

80-992000-2499

100-11192500-2999

120-1393000-3999

140 or4000 more

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 certiffy that informations given are true.

Sex: Male Female Marital status: Single Married Divorcee/Widow/Widower

New i.c.no:

Old i.c.no:

Nationality:

Full name: Date of birth:

A. APPLICANT'S INFORMATION (Enclose copy of certified i.c)

Signature & Date

Name

Passportno:

Work permit expiry date:

CIDB Registration Card No:

Borang Bermasalah Pengesyoran Kategori & Tred

Please √ where applicable. For renewal, information for A, F & G are necessary to fill-up. Please enclose the certified documents as instructed.

NEW REGISTRATION RENEWAL

Race: Religion:

Tel. no.:

Postcode

B. ACADEMIC/SKILL QUALIFICATION (Enclose copy of Technical Cerificate (marked **) if any)

C. INFORMATION OF OCCUPATION

D. EMPLOYER INFORMATION

Income in daily/monthly:

daily monthly

Amount of salary in RM:

Years Years

Field of skills & years of experience (please refer list of trades in the form)

1.

4.

2.

5.

3.

6.

Please √ jif self employed Contractor registration no. with CIDB:

(Fill-up if applicant ages between 16 and 65 years old)

Name:

Sex:

Relationship:

-

Mobile tel no:

Mobiletel. no.:

Postcode

Postcode

Postcode

F. APPLICANT'S DECLARATION

Maklumat pewaris tidak diisi

Salinan sijil ....................................tidak disertakan

Tiada pengakuan pemohon

Tiada pengesahan majikan

Lain-lain:

.................................................................

Bayaran kurang/tiada

Salinan k.p. tiada

Salinan pasport/permit tiada

Permit kerja syarikat lain

Permit kerja bukan binaan

Gambar tiada/tidak sesuai

E. BENEFICIARY INFORMATION

Assistant Construction Manager

Construction Trainee

Pembaharuan

Tukar Kategori

Tukar Tred

KIV

Semakan Ke2:

GW

CW

SW

SS

AM

MG

LT

AD

Master**Degree

Doctor of **Phylosophy

(With capital letter as in i.c/passport)

OFFI

CE U

SE

FemaleMale

Tarikh terima: ........…........................... Bayaran: RM ................................ No. Resit: .................................................................................... REGISTRATION FEE RENEWAL FEE

RM50

RM25

RM50 (5 YEARS)

RM25

RM50(MAXIMUM

OF

RM50RM70RM100

(2 YEARS)(3 YEARS)

(5 YEARS)

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

Local worker

Signature & Date

Name

CERTIFICATION

Others (please specify)

Foreign worker

work permitwith one year or less

Local worker ages between 16 and 65 years

ages above Local worker 65 years

Foreign worker

work permitwith one year or less

Foreign worker with

work permitmore than one year

Foreign worker with

work permitmore than one year RM50

(AS IN

PERMIT)WORK

2 YEARS)

UPP 1 Pin.2/2008