JABATAN IMIGRESEN MALAYSIA

IMMIGRATION DEPARTMENT OF MALAYSIA DP11

MAKLUMAT PEGAWAI DAGANG / EXPATRIATE INFORMATION ( DP11)
Tandakan (X) Dalam Petak Berkenaan / Mark (X) in Approriate Box
A. MAKLUMAT SYARIKAT ATAU MAJIKAN / PARTICULARS OF COMPANY OR EMPLOYER Jenis Permohonan
Type Of Application
1. No Pendaftaran Syarikat / Registration of Company No :
Baru / New
2. Nama Syarikat / Majikan / Name Of Company / Employer

I N S T I T U T K E M A H I R A N M A R A Lanjutan / Extension

K U C H I N G
3. Alamat Syarikat / Majikan / Address Of Company / Employer: Agensi Pelulus / Approving Agency

J A L A N K E M A H I R A N O F F J A L A N JKPD JPA KHEDN

S U L T A N T E N G A H MIDA SC BNM

P E T R A J A Y A MDeC

Poskod / Postcode 9 3 0 5 0 K U C H I N G
Bandar / City

4. No Telefon / Telephone No. : 0 8 2 - 4 4 1 1 4 9 Jenis Pas / Type Of Pass

Pas Penggajian / Employment Pass

5. No Faks/ Fax No. : 0 8 2 - 4 4 4 1 3 5 Pas Lawatan ( Kerja Sementara ) /

Visit Pass (Temporary Employment)
6. E-mail : h a f i z u l l a h@ m a r a . g o v . m y
7. Pegawai Perhubungan Syarikat / Majikan / Contact Person from Company / Employer :

Z A M Z U R I B I N Z A I N A L A B I D I N Lain-lain / Others
8. Jawatan / Position : VDR

P E N G A R A H Tempat / Place :

______________________
B. MAKLUMAT PEGAWAI DAGANG / PARTICULARS OF EXPATRIATE

H A F I Z U L L A H
JP Visa
1. Nama Penuh / Full Name : M O H D
Pas Khas / Special Pass

2.Jantina / Gender : / Lelaki / Male Perempuan / Female Cooling Off Period

3. Tarikh Lahir / Date of Birth :

0 1 /
0 1 /
1 9 8 1 Pinda Tempoh Sahlaku Pas /
Amendment To Validity Of The Pass

4. Warganegara / Nationality : M A L A Y S I A Pindah Pas /

Transfer Endorsement

5. Nombor Pasport / Passport No. : 7 9 6 6 0 4 Lain-lain – Sila Nyatakan

Others – Please State
6. No Pasport Lama / Old Passport No. :
__________________________

9. Tarikh Tamat Pasport / Passport Expiry Date :

2 2 /
0 1 /
2 0 2 1 ___________________________

10. Tempat Dikeluarkan / Place of Issue : K U C H I N G

11. Tarikh Dikeluarkan / Date Of Issue : 2 2 / 0 1 / 2 0 1 6
10. Tarikh Masuk Malaysia / Date Of Entry To Malaysia : / /
11. Alamat di Malaysia / Address in Malaysia :

I N S T I T U T K E M A H I R A N M A R A
K U C H I N G
Tampal Sekeping Gambar
Pegawai Dagang
Poskod / Postcode 9 3 0 5 0 Bandar / City K U C H I N G
Paste A Photo Of Expatriate
12. Jawatan / Position : P E N O L O N G P E G A W A I
(3.5cm X 5.0 cm)
L A T I H A N V O K A S I O N A L
13. Gaji Sebulan / Salary permonth : RM 3 9 9 0 . 0 0
14.Tempoh Pas Dipohon / Duration Of Pass Applied : 6 0 Bulan / Month

15. No Cukai Pendapatan / Income Tax No. : S G 2 0 4 9 6 6 1 0 0 8 0

C. AKUAN / DECLARATION
Saya memperakui bahawa maklumat / kenyataan di atas adalah benar :
I hereby declare that the particulars / informations furnished above are true :

Tandatangan majikan/ Signature of Employer : Cop Syarikat

Nama Penuh / Name : ZAMZURI BIN ZAINAL ABIDIN Company’s Stamp
No. KPT / No. Paspot / I/C. No. / Passport No. : 790518-08-5635
Jawatan / Position : PENGARAH
Tarikh / Date :
Bahagian Pas Penggajian