NEW COMPANY INCORPORATIOn Please fill up the Incorporation Form below For company who has more than 3 directors/shareholders, please email the details of the 4th onwards director/shareholder to [email protected] Phone Company Name Proposed Company Name 1 & its meaning (if any) * Proposed Company Name 2 & its meaning (if any) Proposed Company Name 3 & its meaning (if any) Company Details Nature of Business * Industry Business Address / Intended Business Address Contact Number * Email Address * Initial Share Capital (can start as low as RM1/RM100) * Price per Share (RM) [The common is RM1 per share] * Company Shareholder (Individual) Shareholder is the owner of the company and might not be involve in the day-to-day business operations. Every company needs at least one shareholder. Shareholder 1 Full Name (as per NRIC or Passport) * NRIC or Passport * Nationality * Race * Malay Chinese Indian Other If other, please state Business Occupation * Residential Address * Service Address (if different from residential address) Contact No. * Email Address * Shareholding Number of Shares * Verification Documents IC or Passport Copy (Front) [max file size 200kb] * IC or Passport Copy (Back) [max file size 200kb] * Selfie Holding IC or Passport [max file size 200kb] * Proof of Residential Address (i.e. utility bills) [max file size 200kb] * Due Diligence Are you a politician, a person connected to a politician or holding any important government position? * Yes No Other If other, please specify If your answer is Yes for the above question, kindly disclose all relevant details Source of Fund and/or Wealth * Salary Assets Investment Gambling/Lottery Inheritance Gift Bank/Savings Loan Stock Market Insurance Retirement Income Dividend/Profits from company Others If other, please specify I hereby confirm that my source of fund and/or wealth * are not made on behalf of a third party are not from any unlawful activity Declaration * I am not an undischarged bankrupt I have not been convicted whether within or outside Malaysia of any offence I declare that the information provided in this form is to the best of my knowledge and belief, accurate and complete. I hereby undertake to notify the Company Secretary upon any changes to the above within 10 days from the date of change Shareholder 2 Full Name (as per NRIC or Passport) NRIC or Passport Nationality Race Malay Chinese Indian Other If other, please state Business Occupation Residential Address Service Address (if different from residential address) Contact No. Email Address Shareholding Number of Shares Verification Documents IC or Passport Copy (Front) [max file size 200kb] IC or Passport Copy (Back) [max file size 200kb] Selfie Holding IC or Passport [max file size 200kb] Proof of Residential Address (i.e. utility bills) [max file size 200kb] Due Diligence Are you a politician, a person connected to a politician or holding any important government position? Yes No Other If other, please specify If your answer is Yes for the above question, kindly disclose all relevant details Source of Fund and/or Wealth Salary Assets Investment Gambling/Lottery Inheritance Gift Bank/Savings Loan Stock Market Insurance Retirement Income Dividend/Profits from company Others If other, please specify I hereby confirm that my source of fund and/or wealth are not made on behalf of a third party are not from any unlawful activity Declaration I am not an undischarged bankrupt I have not been convicted whether within or outside Malaysia of any offence I declare that the information provided in this form is to the best of my knowledge and belief, accurate and complete. I hereby undertake to notify the Company Secretary upon any changes to the above within 10 days from the date of change Shareholder 3 Full Name (as per NRIC or Passport) NRIC or Passport Nationality Race Malay Chinese Indian Other If other, please state Business Occupation Residential Address Service Address (if different from residential address) Contact No. Email Address Shareholding Number of Shares Verification Documents IC or Passport Copy (Front) [max file size 200kb] IC or Passport Copy (Back) [max file size 200kb] Selfie Holding IC or Passport [max file size 200kb] Proof of Residential Address (i.e. utility bills) [max file size 200kb] Due Diligence Are you a politician, a person connected to a politician or holding any important government position? Yes No Other If other, please specify If your answer is Yes for the above question, kindly disclose all relevant details Source of Fund and/or Wealth Salary Assets Investment Gambling/Lottery Inheritance Gift Bank/Savings Loan Stock Market Insurance Retirement Income Dividend/Profits from company Others If other, please specify I hereby confirm that my source of fund and/or wealth are not made on behalf of a third party are not from any unlawful activity Declaration I am not an undischarged bankrupt I have not been convicted whether within or outside Malaysia of any offence I declare that the information provided in this form is to the best of my knowledge and belief, accurate and complete. I hereby undertake to notify the Company Secretary upon any changes to the above within 10 days from the date of change Corporate Shareholder For non-corporate shareholder, please skip and ignore this page. Company Name Company Registration No. Date of Incorporation Place of Incorporation (i.e. Malaysia, Singapore, Thailand, US, UK) Type of Body Corporate Government Agencies/Institution/Statutory Bodies Controlled by Malaysian (Malay Natives) Controlled by Malaysian (Non-Malays/Non-Natives) Controlled by Non-Malayisan N/A Registered Office Address Business Address (if different from registered address) Contact No. Email Address Website (if any) Shareholding Number of Shares Corporate Representative Full Name (as per NRIC or Passport) NRIC or Passport No. Designation Verification Documents Certificate of Incorporation (i.e. Form 9 or Section 14) [max file size 200kb] Company Profile / Annual Return (Please upload a copy of company profile from SSM or latest Annual Return) [max file size 200kb] Certificate of Authorised Corporate Representative Please submit a copy of the certificate of authorised corporate representative to us. Kindly get your company secretary to prepare the said documents. Please send a copy to us at [email protected] once signed. Declaration Declaration I declare that the information provided in this form is to the best of my knowledge and belief, accurate and complete. I hereby undertake to notify the Company Secretary upon any changes to the above within 10 days from the date of change Company Director Company Director is usually the person who is in-charge of the day-to-day operations of the business. Every company needs to have at least one local resident director. Director 1 Full Name (as per NRIC/Passport) * Are you a Shareholder too? * Yes No If you're also a shareholder, can skip the rest and proceed to the Declaration part NRIC / Passport No. Nationality Race Malay Chinese Indian Other If other, please state Business Occupation Residential Address Service Address (if different from residential address) Contact No. Email Address Verification Documents IC or Passport Copy (Front) [max file size 200kb] IC or Passport Copy (Back) [max file size 200kb] Selfie holding IC or Passport [max file size 200kb] Proof of Residential Address (i.e. utility bills) [max file size 200kb] Due Diligence Are you a politician, a person connected to a politician or holding any important government position? Yes No Other If other, please specify If your answer is Yes for the above question, kindly disclose all relevant details Source of Fund and/or Wealth Salary Assets Investment Gambling/Lottery Inheritance Gift Bank/Savings Loan Stock Market Insurance Retirement Income Dividend/Profits from company Others If other, please specify I hereby confirm that my source of fund and/or wealth are not made on behalf of a third party are not from any unlawful activity Declaration * I am not an undischarged bankrupt I have not been convicted whether within or outside Malaysia of any offence I declare that the information provided in this form is to the best of my knowledge and belief, accurate and complete. I hereby undertake to notify the Company Secretary upon any changes to the above within 10 days from the date of change Director 2 Full Name (as per NRIC/Passport) Are you a Shareholder too? Yes No If you're also a shareholder, can skip the rest and proceed to the Declaration part NRIC / Passport No. Nationality Race Malay Chinese Indian Other If other, please state Business Occupation Residential Address Service Address (if different from residential address) Contact No. Email Address Verification Documents IC or Passport Copy (Front) [max file size 200kb] IC or Passport Copy (Back) [max file size 200kb] Selfie holding IC or Passport [max file size 200kb] Proof of Residential Address (i.e. utility bills) [max file size 200kb] Due Diligence Are you a politician, a person connected to a politician or holding any important government position? Yes No Other If other, please specify If your answer is Yes for the above question, kindly disclose all relevant details Source of Fund and/or Wealth Salary Assets Investment Gambling/Lottery Inheritance Gift Bank/Savings Loan Stock Market Insurance Retirement Income Dividend/Profits from company Others If other, please specify I hereby confirm that my source of fund and/or wealth are not made on behalf of a third party are not from any unlawful activity Declaration I am not an undischarged bankrupt I have not been convicted whether within or outside Malaysia of any offence I declare that the information provided in this form is to the best of my knowledge and belief, accurate and complete. I hereby undertake to notify the Company Secretary upon any changes to the above within 10 days from the date of change Director 3 Full Name (as per NRIC/Passport) Are you a Shareholder too? Yes No If you're also a shareholder, can skip the rest and proceed to the Declaration part NRIC / Passport No. Nationality Race Malay Chinese Indian Other If other, please state Business Occupation Residential Address Service Address (if different from residential address) Contact No. Email Address Verification Documents IC or Passport Copy (Front) [max file size 200kb] IC or Passport Copy (Back) [max file size 200kb] Selfie holding IC or Passport [max file size 200kb] Proof of Residential Address (i.e. utility bills) [max file size 200kb] Due Diligence Are you a politician, a person connected to a politician or holding any important government position? Yes No Other If other, please specify If your answer is Yes for the above question, kindly disclose all relevant details Source of Fund and/or Wealth Salary Assets Investment Gambling/Lottery Inheritance Gift Bank/Savings Loan Stock Market Insurance Retirement Income Dividend/Profits from company Others If other, please specify I hereby confirm that my source of fund and/or wealth are not made on behalf of a third party are not from any unlawful activity Declaration I am not an undischarged bankrupt I have not been convicted whether within or outside Malaysia of any offence I declare that the information provided in this form is to the best of my knowledge and belief, accurate and complete. I hereby undertake to notify the Company Secretary upon any changes to the above within 10 days from the date of change Service Terms Please read through our service terms: click here I hereby acknowledged that I had read and accepted the service terms * Yes No
