Pr1maform

Nama seperti di dalam IC / Name as stated in NRIC*

No. Kad Pengenalan (Baru) / NRIC (New)*

Tarikh lahir / D.O.B.*

Warganegara / Nationality*
MalaysianNon-Malaysian

Your email*

No. telefon bimbit / Mobile number.*

ID pengguna / User ID*

Soalan sekuriti jika anda terlupa kata laluan / Security question*
---Apakah filem kegemaran anda ?/What is your favourite movie ?Apakah Jenama Kereta Pertama Yang anda milik ?/What was your first car?Apakah Nama Haiwan Pertama Kesayangan anda?/What was the name of your first pet?Apakah warna Kegemaran anda?/What is your favorite colour?Di Bandar manakah anda dilahirkan/In what city were you born?

Jawapan sekuriti jika anda terlupa kata laluan / Answer to question*

Kata Laluan / Password*

Masuk Kata Laluan Sekali Lagi / Re-enter New Password*

Apakah pendapatan purata kasar bulanan anda? (RM/Bulan) / What is your monthly gross personal income? (RM/Month)*

Adakah anda pernah diisytiharkan muflis? / Have you been declared bankrupt?*
Ya / YesTidak / No

Jika ya, adakah anda telah bebas dari muflis? / If yes, have you been discharged from bankruptcy?*
Ya / YesTidak / No

Pengenalan ID lain / Other ID type*
Tiada / NoneNo. Tentera / Army No.No. Polis / Police No.

Gelaran / Title*
---Cik/MsEn/MrPn/MrsLain-Lain/Others

Jantina / Gender*
Lelaki / MalePerempuan / Female

Bangsa / Race*
---Bumiputra SabahBumiputra SarawakCina/ChineseIndia/IndianMelayu/MalaySikh/PunjabiLain-Lain/Others

Taraf perkahwinan / Marital status*
---Bujang/SingleBerkahwin/MarriedDuda atau Janda (Bercarai)/(Divorced)Duda atau Janda/WidowedBerpisah/Separated

Adakah anda mempunyai anak? / Do you have children?*
Ya / YesTidak / No

Bilangan anak / Number of children*

Alamat Rumah / Home Address*

Telefon rumah / Home phone*

Pemilikan kediaman di atas / Ownership of above property*
---Milik Ibu Bapa/ParentsMilik Saudara/RelativesMilik Sendiri/OwnSewa/RentalLain-Lain/Others

Bilangan hartanah yang dimiliki anda dan/atau pasangan anda / No. of properties that are currently owned by you and/or your spouse(s)*

Negeri kelahiran / State of birth*
---JohorKedahKelantanMelakaNegeri SembilanPahangPerakPerlisPulau PinangSabahSarawakSelangorTerengganuWilayah Persekutuan Kuala LumpurWilayah Persekutuan LabuanWilayah Persekutuan Putrajaya

Kurang upaya / Disability*
---Tidak Berkenaan/NoneKurang Upaya Fizikal/Physical DisabilityKurang Upaya Mental/Mental DisorderKurang Upaya Pelbagai/Various DisabilitiesKurang Upaya Pendengaran/Hearing DisabilityKurang Upaya Penglihatan/Visual DisabilityKurang Upaya Pertuturan/Speed DisorderMasalah Pembelajaran/Learning Disorder

Status pekerjaan / Employment status*
---Bekerja - Kejaraan/Employed-GovernmentBekerja - Swasta/Employed-PrivateBekerja Sendiri/Self EmployedBersara/PensionerTidak Bekerja/Unemployed

Taraf pendidikan / Education level*
---Pendidikan Rendah/PrimaryPendidikan Menengah Rendah/Lower SecondaryPendidikan Menengah Atas/Upper SecondaryDiploma/DiplomaIjazah/BachelorIjazah Lajuntan/MasterKedoktoran/DoctorateKelayankan Professional/Professional Qualification