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