1. FORM IS GIVEN
FOR FREE
Lembaga Pembangunan
Industri Pembinaan Malaysia
CONSTRUCTION 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.
Primary
Others (please specify)
General
Worker
Daily
Monthly
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
30-39
500-749
40-49
750-999
50-59
1000-1499
60-79
1500-1999
80-99
2000-2499
100-1119
2500-2999
120-139
3000-3999
140 or
4000 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
Passport
no:
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:
Mobile
tel. 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)
OFFICEUSE
FemaleMale
Tarikh terima: ........…........................... Bayaran: RM ................................ No. Resit: ....................................................................................
REGISTRATION FEE RENEWAL FEE
RM50
RM25
RM50 (5 YEARS)
RM25
RM50
(MAXIMUM
OF
RM50RM70
RM100
(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 permit
with one year or less
Local worker
ages between
16 and 65 years
ages above
Local worker
65 years
Foreign worker
work permit
with one year or less
Foreign worker with
work permit
more than one year
Foreign worker with
work permit
more than one year RM50
(AS IN
PERMIT)
WORK
2 YEARS)
UPP 1 Pin.2/2008