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Kuala Lumpur
Friday, August 12, 2022
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MPLMA Membership Application Form
MPLMA Membership Application Form
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Name of Applicant
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Last
Home Address
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NRIC No.
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Contact Number (Landline)
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Mobile Number
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Gender
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Male
Female
Email
*
Introducer Name
Company Name
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Designation
*
Company Type
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Sole Proprietor
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Company Registration Number
*
Company License No.
*
License Expiry Date
*
Company Address
*
Office Contact Number
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Office Fax Number
Company Email
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Company Contact Person
*
Designation of Contact Person
Contact Person Mobile Number (WhatsApp)
*
Consent - Insert your Full Name
I hereby agree that all information provided above is true & hereby agree to abide all rules & regulations of MPLMA.
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