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Application Form Steps:

1. Membership Share
2. Personal Info
3. Beneficiary Info
4. Dependants Info
5. Application Submit

Membership Application

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Step 1 of 5 : Membership Share
Membership Share
Share Amount	RM
Membership Fee	RM
Membership Fee Payment Installment

Step 2 of 5 : Personal Info
General Info
Full Name
Gender	Select...MaleFemale
Maritial Status	Select...Select...SingleMarriedDivorced
Education	Select...Select...Primary/Secondary School/SPM/"O" LevelHigher Secondary/STPM/"A" Level/Pre-UProfessional CertificateDiplomaAdvanced/Higher/Graduate DiplomaBachelor DegreePost Graduate DiplomaProfessional DegreeMaster DegreeDoctorate (PhD)
Identification Number
Birth Date	Format: DD/MM/YYYY
Contacts
Home Phone
Office Phone
Home Fax
Office Fax
Mobile Phone
Email Address
Employment
Employer	Select...MaxisMALAYSIA MARINE AND HEAVY ENGINEERING SDN BHD
Location(Branch)	N/A
Employee Id
Position
Gross Salary
Net Salary
Permanent Address
Country	MalaysiaOther...
State	Select...JohorKedahKelantanMelakaNegeri SembilanPahangPerakPerlisPulau PinangSelangorSabahSarawakTerengganuWP Kuala LumpurWP LabuanWP Putrajaya
Postal code
Town
Address1
Address2
Residential Address
Copy from permanent address
Country	MalaysiaOther...
State	Select...JohorKedahKelantanMelakaNegeri SembilanPahangPerakPerlisPulau PinangSelangorSabahSarawakTerengganuWP Kuala LumpurWP LabuanWP Putrajaya
Postal Code
Town
Address1
Address2
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Step 3 of 5 : Beneficiary Info
General Info
Full Name
Relationship	Select...Select...SpouseParentChildSibling
Gender	Select...MaleFemale
Maritial Status	Select...Select...SingleMarriedDivorced
Education	Select...Select...Primary/Secondary School/SPM/"O" LevelHigher Secondary/STPM/"A" Level/Pre-UProfessional CertificateDiplomaAdvanced/Higher/Graduate DiplomaBachelor DegreePost Graduate DiplomaProfessional DegreeMaster DegreeDoctorate (PhD)
Identification Number
Birth Date	Format: DD/MM/YYYY
Permanent Address
Country	MalaysiaOther...
State	Select...JohorKedahKelantanMelakaNegeri SembilanPahangPerakPerlisPulau PinangSelangorSabahSarawakTerengganuWP Kuala LumpurWP LabuanWP Putrajaya
Postal code
Town
Address1
Address2
Residential Address
Copy from bnfmanent address
Country	MalaysiaOther...
State	Select...JohorKedahKelantanMelakaNegeri SembilanPahangPerakPerlisPulau PinangSelangorSabahSarawakTerengganuWP Kuala LumpurWP LabuanWP Putrajaya
Postal Code
Town
Address1
Address2
or Go back

Select MaleFemale

Select Select...SingleMarriedDivorced

Select Select...SpouseParentChildSibling

Select Select...Primary/Secondary School/SPM/"O" LevelHigher Secondary/STPM/"A" Level/Pre-UProfessional CertificateDiplomaAdvanced/Higher/Graduate DiplomaBachelor DegreePost Graduate DiplomaProfessional DegreeMaster DegreeDoctorate (PhD)

Delete

Step 4 of 5 : Dependants Info

Name Iden No Birth Date (DD/MM/YYYY) Gender Maritial Status Relationship Education Notes

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Step 5 of 5 : Application Submit
Do you agree?	I have read and agree to the Terms of Membership
Type the code shown
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