Form A

REGISTRATION OF BUSINESS RULES 1957

[RULE 3] - PORTAL Reference No:
BUSINESS REGISTRATION EB-A2020062402240

(* Mandatory Field)

NAME APPROVAL NO. EB-A2020062402240

I/We the person(s) responsible submit for registration of the following particulars regarding the under-mentioned business.

INFORMATION OF BUSINESS (* Mandatory field)

1. * BUSINESS NAME PIZZA PADU ENTERPRISE

2. A) * DATE OF COMMENCEMENT OF BUSINESS 24/06/2020 B) * REGISTRATION 1 YEARS

(dd/mm/yyyy) PERIOD
3. * PARTNERSHIP AGREEMENT N DATE
(If yes, upload the copy of agreement) (dd/mm/yyyy)
4. ADDRESS OF PRINCIPAL PLACE OF BUSINESS 25 TAMAN LAGENDA
JALAN KAMPUNG SAWAH, BUKIT PELANDUK
PORT DICKSON
TOWN PORT DICKSON

POSTCODE 71960

STATE N

5. * TELEPHONE 0183979741 FAX

6. E-MAIL azimahsobri@gmail.com

7. CORRESPONDENCE ADDRESS 25 TAMAN LAGENDA

(if different from above) JALAN KAMPUNG SAWAH, BUKIT PELANDUK
PORT DICKSON

TOWN PORT DICKSON

POSTCODE 71960

STATE N
 Form A
REGISTRATION OF BUSINESS RULES 1957
[RULE 3] - PORTAL Reference No:
BUSINESS REGISTRATION EB-A2020062402240

INFORMATION OF BRANCHES (* Mandatory field)

* NO OF BRANCHES 0

NO BRANCH ADDRESS TOWN POSTCODE STATE

INFORMATION TYPE OF BUSINESS (* Please fill in at least 1)

BUSINESS DESCRIPTION

SALE OF FOOD PRODUCT (FAST FOOD)

SALE OF FOOD PRODUCT (FROZEN)

NO BUSINESS TYPE (CODE) DESCRIPTION

SUBMISSION DATE 24/06/2020

(dd/mm/yyyy)
 Form A
REGISTRATION OF BUSINESS RULES 1957
[RULE 3] - PORTAL Reference No:
BUSINESS REGISTRATION EB-A2020062402240

INFORMATION OF OWNERS (* Mandatory field)

 Form A
REGISTRATION OF BUSINESS RULES 1957
[RULE 3] - PORTAL Reference No:
BUSINESS REGISTRATION EB-A2020062402240

VERIFICATION BY OWNER/PARTNER(S) (* Mandatory field)

I/We confirm the accuracy of all the statements made in the form and declare that I/We am/are the owner/partner(s) of
the business the name of which is
PIZZA PADU ENTERPRISE

* NAME NOOR AZIMAH BINTI SOBRI

* PERSONAL IDENTIFICATION NO. 830324016352 * COLOUR BLUE

* ADDRESS NO 248 BLOK 5

FELDA LUI SELATAN 2

TOWN BANDAR SERI JEMPOL

POSTCODE 72120

STATE 05

* E-MAIL azimahsobri@gmail.com
* TELEPHONE 0183979741
FAX
 Form A
REGISTRATION OF BUSINESS RULES 1957
[RULE 3] - PORTAL Reference No:
BUSINESS REGISTRATION EB-A2020062402240

VERIFICATION BY OWNER/PARTNER(S)

NO. NAME IDENTITY CARD NO COLOUR SIGNATURE