UPP 1

Lembaga Pembangunan
Industri Pembinaan Malaysia
CONSTRUCTION INDUSTRY DEVELOPMENT BOARD

http:/www.cidb.gov.my

RENEWAL

Please where applicable. For renewal, information for A, F & G are necessary
to fill-up. Please enclose the certified documents as instructed.

A. APPLICANT'S INFORMATION

The Construction Personnel Registration Programme is based to Pekeliling

Program Kad Hijau CIDB Bil.1/2000 dan Bil.1/2001.
General instruction:
- This Form is to be read together with Construction Personnel Registration
Requirements & Procedures.

Date of
birth:

Wong Ming Ming

Passport Size Photo

with blue background

01/01/1990

(With capital letter as in i.c/passport)

New i.c.
no:

PHOTO MUST BE SHARP

& CLEAN

CIDB Registration Card No:

(Enclose copy of certified i.c)

Full name:

Please paste one recent

i.c. size colour photograph
with glue. Do not use
stapler/cut the photo.

CONSTRUCTION PERSONNEL
REGISTRATION FORM

Tingkat 10, Menara Dato' Onn,, Pusat Dagangan Dunia Putra,

No 45, Jalan Tun Ismail, 50480 Kuala Lumpur
Tel: 03-4047 7000 Fax No : 03-4047 7070

NEW REGISTRATION

Pin.1/2014

PHOTO

FORM IS GIVEN
FOR FREE

Old i.c.
no:

900101-13-1234

Malaysian

Nationality:

EXTRA INFORMATIONS TO BE FILLED-UP BY FOREIGN WORKER

Passport
no:

Work permit
expiry date:

Race:

Chinese

Sex:

(Enclose copy of passport with valid work permit certified by employer as appear on work permit)

Male

Correspondence address:

Religion:

Female

Marital status:

Christian

Single

Married

Divorcee/Widow/Widower

Permanent address if different:

No. 1, Jalan Tabuan

Kuching, Sarawak
Mobile 012 123 4567

93350
Postcode
Tel. no.:

Postcode

tel. no.:

B. ACADEMIC/SKILL QUALIFICATION
SRP/LCE
/PMR

Primary

SPM
/MCE

Others (please specify)

(Enclose copy of Technical Cerificate (marked **) if any)

Polytechnic**
Diploma**
SKM**/
Degree**
SPVM**

Master**
Degree

C. INFORMATION OF OCCUPATION
General
Worker

Construction
Worker

Income in daily/monthly:
daily

monthly

Skilled
Construction
Worker

Doctor of **
Phylosophy
Others (please specify)

Construction
Site
Supervisor

Assistant
Construction
Manager

Amount of salary in RM:

Daily
<29
Monthly
<499

30-39
500-749

Construction
Site Manager

Construction
Trainee

40-49
750-999

50-59
1000-1499

Administrative
Personnel

60-79
1500-1999

Student
80-99
2000-2499

100-1119
2500-2999

120-139
3000-3999

140 or
4000 more

Field of skills & years of experience (please refer list of trades in the form)
1.

Years

2.

Years

3.

Years

4.

Years

5.

Years

6.

Years

D. EMPLOYER INFORMATION
Company name and address:

Contractor registration no. with CIDB:

Please jif self employed

Swinburne University of Technology

Jalan Simpang Tiga
Kuching, Sarawak
93350
Postcode
E. BENEFICIARY INFORMATION

Sex:

Wong Teck Siong

I.c. no./
Birth cert. 580831-13-1233
Male

Relationship:
Tel. no:

Female

/passport (if available)

Father
012 111 2345

Fax
no:

082-416353

F. APPLICANT'S DECLARATION

(Fill-up if applicant ages between 16 and 65 years old)

Name:

Tel
no:
Mobile
tel no:

G. CERTIFICATION
(Certification can be made by officers as stated in
the registration procedure. For foreign worker,
certification can only be done by employer as
appeared in the work permit).

I hereby certify that all the informations given

and copy/ies of document/s enclosed with this
form are right and true.
Application/Registration will be automatically
deemed nullified for any false information and
action including lawsuit can be taken.

I hereby certiffy that informations given are true.

To be certified and
CERTIFICATION
stamped
by the SIC

Sign and date

Permanent address if different than applicant's address:

082-260813

Signature & Date

Signature & Date

Wong Ming Ming

Postcode

RM50

Foreign worker
with one year or less
work permit

RM25
RM50

Payment can be made by

money order or bank draft
made payable to CIDB
Malaysia. Cash payment can
only be accepted for
submission at CIDB counter

RENEWAL FEE
Local worker
ages between
16 and 70 years
Local worker
ages above
70 years
Foreign worker
with one year or less
work permit
Foreign worker with
more than one year
work permit

Tarikh terima:

RM50
RM50
RM70
RM100

(2 YEARS)
(3 YEARS)
(5 YEARS)

RM50

(5 YEARS)

RM25
RM50

(AS IN
WORK
PERMIT)
(MAXIMUM
OF
2 YEARS)

...................................

Bayaran: RM

................................

No. Resit: ....................................................................................

Borang Bermasalah

OFFICE USE

REGISTRATION FEE
Local worker

Foreign worker with

more than one year
work permit

Name

Name

Pengesyoran Kategori & Tred

Bayaran kurang/tiada

Maklumat pewaris tidak diisi

GW

Pembaharuan

Salinan k.p. tiada

Salinan sijil ....................................

tidak disertakan

CW

Tukar Kategori

SW

Tukar Tred

Salinan pasport/permit tiada

Tiada pengakuan pemohon

SS

KIV

Permit kerja syarikat lain

Tiada pengesahan majikan

Permit kerja bukan binaan

Lain-lain:

AM
MG

Gambar tiada/tidak sesuai

LT
AD

Semakan Ke2:

.................................................................

Please photocopy your IC, SPM result and student ID, and bring them with your original one to SIC for
certification and stamp. Attach the certified copies with this form for submission.
For foreigners, please photocopy your passport photo page and visa page instead of IC.