Borang R1 95 CIDB

					A. Maklumat Pemohon
   Particulars of Applicant


  No. Pendaftaran Perniagaanfiyarikat:
  Registration No. Of BusinesslCompany

  Alamat BerdaftarlRegisteredAddress:          Alamat Surat-MenyuratlCorrespondence Address:




  Poskodlpostcode:                              PoskodlPostcode:

  Tel:                        Fax:                       E-mail:


B. Gred, Kategori dan Pengkhususan Dipohon (sila rujuk buku panduan sebelum
  mengisi bahagian ini)
  Grade, Category and Specialization Applied For (Please refer the guide book before
  completing this section)




C. Tempoh Pendaftaran Dipohon: (Tanda / salah satu yang berkaitan)
   Period ofRegistration Applied For: (Mark J whichewr applicable)

  a. Dua (2) Tahun
     Two (2) Years
                                         b. Tiga (3) Tahun
                                            Three (3) Years   0
D. Maklumat Surnber Kewangan
   Particulars of Financial Resources

    Lengkapkan butir-butir di bahagian
    Complete details in section

    (i)   -   Bagi firma pemilik tunggal atau perkongsian ATAU
              For sole proprietorship or partnership firm OR

    (ii) -    Bagi syarikat sendirian berhadlsyarikat berhadlkoperasi dan lain-lain
              For private limited companylpublic companylcooperative and others

    (i) FIRMA PEMILIKAN TUNGGAL ATAU PERKONGSIAN
         SOLE PROPRIETORSHIP OR PARTNERSHlP FIRM



              Baki penyata akaun bank untuk tiga bulan yang terkini
              Balance o f the latest three months bank account statements

              a) RM ...............................................
              b) RM ............................................    Jumlah (Total) i 3 =
              c) RM ............................................ I
              Amaun kemudahan overdraf
              Amount of overdraft facilities
              Simpanan tetap (termasuk simpanan tetap pemilik tunggal atau setiap
              rakan kongsi) yang tidak dicagar pada mana-mana bank atau institusi
              kewangan
              Fixed deposit(s) (including deposit(s) of sole proprietor or each partner)
              which islare not charged to any bank or financial institution
              Baki di akaun simpanan (termasuk akaun simpanan pemilik tunggal atau
              setiap rakan kongsi)
              Balance in savings account (including savings account of sole proprietor
              or each partner)
              Lain-lain (Saham ASBlASN dll.) Others (ASBIASN Shares etc.)




    (ii) SYARIKAT SENDIRIAN BERHADlSYARlKAf BERHAD/KOPERASI DAN LAIN-LAIN
         PRIVATE LIMITED COMPANYlPUBLIC COMPANYICOOPERATIVE AND OTHERS

                                                                                           D
    1.        Jumlah modal berbayarlsaham anggota dimiliki oleh badanlindividutempatan
              Tota1 paid-up capitallshares of members owned by local bodiedindividualts)

    2.        Jumlah modal berbayar dimiliki oleh badadindividu asing
              Total paid-up capital owned by foreign bodieslindividual(s)

                                                                            Jumlah/Total
                                                                                           I


    1.        Jumlah Aset tolak Jumlah Liabiliti berdasarkan lembaran imbangan terkini
              Total Assets less Total Liabilities based on latest balance sheet
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E. Maklumat PemiliklRakan KongsilAhli PengarahlAhli Lembaga dan Personel Teknikal yang Digaji Sepenuh Masa
   Particulars of the Owner1 Partner(s)/Director(s)/Board Memher(.) and Full Time Technical Personnel




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     Sila kemukakan salinan kad pengenalanlplease submit copy of identity card.

  O Sila kemukakan salinan sijil berkaitan. Jurutera, Arkitek dan Jurukur Bahan htndaklah mengemukakan salinan pendaftaran dengan Lembaga masing-masing.
    Please submit a copy of the relevant certificate. Engineers, Architects and Quantity Surveyors should present a copy of registration with their respective Board.
  # 5iIa kemukakan senarai pengalaman yang menyenaraikan jenis dan saiz projek yang dikawalselia atau diuruskan bersama dengan swat sokongan dari majikan seperti
     surat tawaran jawatan atau wurnpamanya.
     Please submit nsume listing type and sire of projects supervised or managed, together with supporting documents from employer(s) such as employment letters and
     likewise
                                                                                                                                     -
                                 Lembaga Pembangunan lndustri Pembinaan Malaysia
                                 CONSTRUCrlON IND-USTRY DEVELOPMENT BOARD MALAYSIA
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   CiDB                          Bahag ian PemEarigunan Personel 8i-n      (Construction Manpower Development Division)
     L   *   y   s 1a            Lot 8, Jalan Chan Sow Lin, 55200 Kuala Lumpur. Te!: 03-982 7272, Fax: 03-982 0502
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MAKLUMAT PERSONEL BlNMN (CONSTRUCTION PERSONNEL INFORMATION)
Kontraktor dikehendaki menyatakan maklumat*semua kakitangan erronel bina-an di 5 arikat di
bawah kate ori Pengurur Tapak Binaan, Penyeha Tapak Blnaan, Pe erja Mahtr Blnaan 8ekerla
                        4
Separuh Ma ir Binaan dan Pekerja Am Blnaan dengan rnenglsl jadual dl bawah. (S~la
                                                                                buat sa inan, jika
                                                                                                                                 R
perlu).
Contractors are required to declare the information regarding a/! constrvct!on personnel in the company
under the cate ory of Construct~on Mana er, Constructton Stte Superv~sor,
                                    Site                                       Skilled Construction
                            i!                                                          B
Worker Semi-s illed Construction Worker an General Construction Worker by filling up the foliowing
table. hiease make co~ies, reauiredl.
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Description: Borang R1 95 CIDB
Deen Yusof Deen Yusof Basic Worker
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