Khidmat Imigran Program > Renewal Form View

Payment Info

Receipt No.

Date Receipt *

Death Benefit Expired (Based on receipt date) *

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APPLICANT PERSONAL INFORMATION

certificate id AUTO

FDC No.

NAME *

DATE OF BIRTH *

ORIGIN COUNTRY *

SEX *

MALE FEMALE

RELIGION *

STATUS *

NO. TEL *

EMAIL

ADDRESS 1 *

ADDRESS 2 *

STATE *

POSCODE *

CITY *

ADDITIONAL INFORMATION

INFO

UPLOAD PASSPORT PHOTO *

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INFO

UPLOAD SUPPORTING DOCUMENT *

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IMMIGRATION INFORMATION

CITIZENSHIP

RESIDENCE STATUS *

AGE STATUS *

RACE

MARITAL STATUS *

ID NO. (ORIGIN COUNTRY)

INFO

PASSPORT NO.

PASSPORT DATE OF ISSUE

PASSPORT EXPIRED DATE

OCCUPATION SECTOR

SECTOR OCCUPATION *

Setiap pemohon Kad Prabayar Visa wajib mengisi maklumat pekerjaan & pastikan passport masih sah dengan tarikh luput tidak kurang dari 6 bulan.

Jika maklumat lengkap klik YES / Jika tidak klik NO

Every Visa Prepaid Card applicant is required to fill out their employment information & make sure the passport with the expiration date is not less than 6 months.

If the information is complete click YES / click NO If not

EMPLOYMENT / BUSINESS DETAIL *

YES NO

EMPLOYMENT / BUSINESS DETAILS

POSITION *

COMPANY NAME / WORK NAME (SELF EMPLOYED) *

COMPANY REGISTRATION NO.

COMPANY TEL. NO. *

ADDRESS 1 *

ADDRESS 2 *

POSCODE *

STATE *

Category (DP-10)

INFO

*According to the information provided, all applicants from the country at risk are required attach additional documents as directed by Bank Negara Malaysia to get Prepaid Card Service. High risk countries listed are as follows:

*Merujuk kepada makluman yang diberikan, kesemua pemohon dari negara yang berisiko perlu melampirkan dokumen tambahan seperti yang diarahkan oleh pihak Bank Negara Malaysia untuk mendapat Perkhidmatan Kad Prabayar. Negara berisiko tinggi yang tersenarai adalah seperti berikut:

PAKISTAN
CAMBODIA
MYANMAR
SYRIA
GHANA
BAHAMAS
BOSTWANA
PANAMA
TRINIDAD TOBAGO
ICELAND
MONGOLIA
ZIMBABWE
YEMEN
ALBANIA
BARBADOS
JAMAICA
MAURITUS
NICARAGUA
UGANDA

VISA OR PERMIT COPY

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UTILITY BILL COPY

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STATUS

REFERENCE NO.

DOC INFO

DOC DATE OF ISSUE

DOC EXPIRED DATE

BENEFICIARY (ORIGIN COUNTRY)

MOTHER NAME *

BENEFICIARY NAME *

ID NO

RELATIONSHIP *

MOBILE PHONE NO. *

PHONE NO. (HOME)

ADDRESS 1 *

ADDRESS 2 *

POSTCODE

CITY

STATE

COUNTRY *

SPOUSE/FAMILY/FRIENDS INFORMATION (IN MALAYSIA)

NAME *

RELATIONSHIP *

TEL. NO *

IMMIGRANT ISSUE

IMMIGRANT ISSUE *

OTHERS IMMIGRANT ISSUE

EDUCATION CATEGORY

EDUCATION LEVEL

Renewal Information

Date Renewal

Death Compensation Expired

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Then Click Button 'Renew Now' to proceed

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