Agent Registration
Login ID*
Password*
Introducer
Confirm Password*
Company Details
Company/Applicant
Name*
Billing Address*
Bus. Reg. No/IC No*
Postcode*
Type Of Business*
Country*
West Malaysia
East Malaysia
Singapore
Contact No.1*
State*
Johor
Kedah
Kelantan
Melaka
Negeri Sembilan
Pahang
Perak
Perlis
Pulau Pinang
Selangor
Terengganu
Wilayah Persekutuan
Contact No.2
City*
Fax No.
Individual Application Details
Applicant Name*
IC No. *
Mobile Phone No.*
Position
Gender
Male
Female
Race
Chinese
Indian
Malay
Other
Nationality *
Email *
Person Incharge Details
P. Incharge Name*
E-mail Address*
Contact No.*
Mobile Phone No
Type*
Bank In
Bank Transfer
Cash Deposit
Cheque
Cheque Deposit
Bank*
Hong Leong Bank
Maybank
OCBC Bank
RHB Bank
Public Bank
AmBank
Prepaid Amount*
(Minimum deposit RM 100)
Click to see Bank Accounts
Payment Slip*
Please upload only jpg, png, or pdf files. File size must be 1MB or below
I have read and agree to the
Agent's Membership Terms & Condition.