NOTE: BEFORE FILLING IN PARTICULARS, ENSURE DETAILS ARE CORRECT ESPECIALLY FOR
1) CIDB EXPIRY DATE, PLEASE REFER TO CIMS SYSTEM FOR PROPER EXPIRY DATE,
EXPIRY DATE ON CARD MAY DIFFER FROM EXPIRY DATE ON SYSTEM
2) ENSURE PHOTOGRAPHIC EVIDENCE IS CLEAR, UNCLEAR DETAILS WILL BE REJECTED
COMPANY NAME:
COMPANY/HR/PERSON-IN-CHARGE E-MAIL:
TOTAL WORKERS FOR INDUCTION:
DATE:
A) PERSONNEL PARTICULARS
NAME: ROSLAN BIN MOHAMED YUSOF
IC NO/ PASSPORT NO: 800128105625
CIDB CARD/SICW NO:
CIDB CARD/ SICW EXPIRY DATE:
B) PHOTOGRAPHIC EVIDENCE (CLEAR PHOTO ONLY)
IC/PASSPORT FRONT
IC BACK
NOTE: BEFORE FILLING IN PARTICULARS, ENSURE DETAILS ARE CORRECT ESPECIALLY FOR
1) CIDB EXPIRY DATE, PLEASE REFER TO CIMS SYSTEM FOR PROPER EXPIRY DATE,
EXPIRY DATE ON CARD MAY DIFFER FROM EXPIRY DATE ON SYSTEM
2) ENSURE PHOTOGRAPHIC EVIDENCE IS CLEAR, UNCLEAR DETAILS WILL BE REJECTED
CIDB CARD/ SICW CERT/ CLEAR SCREENHOT FROM CIMS SYSTEM
PASSPORT SIZE PHOTO
VACCINATION STATUS FROM MYSEJAHTERA