Form A

REGISTRATION OF BUSINESS RULES 1957

[RULE 3] - PORTAL Reference No:
BUSINESS REGISTRATION EB-A2020122100054

(* Mandatory Field)

NAME APPROVAL NO. EB-A2020122100054

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 HAPPY FROSTBITE MEAL

2. A) * DATE OF COMMENCEMENT OF BUSINESS 21/12/2020 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 21, JALAN DESA 7/12 BANDAR COUNTRY HOMES

TOWN RAWANG

POSTCODE 48000

STATE B

5. * TELEPHONE 01115687423 FAX

6. E-MAIL hasanah_razali@yahoo.com

7. CORRESPONDENCE ADDRESS 21, JALAN DESA 7/12 BANDAR COUNTRY HOMES

(if different from above)

TOWN RAWANG

POSTCODE 48000

STATE B
 Form A
REGISTRATION OF BUSINESS RULES 1957
[RULE 3] - PORTAL Reference No:
BUSINESS REGISTRATION EB-A2020122100054

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

FOOD PRODUCT

NO BUSINESS TYPE (CODE) DESCRIPTION

SUBMISSION DATE 21/12/2020

(dd/mm/yyyy)
 Form A
REGISTRATION OF BUSINESS RULES 1957
[RULE 3] - PORTAL Reference No:
BUSINESS REGISTRATION EB-A2020122100054

INFORMATION OF OWNERS (* Mandatory field)

 Form A
REGISTRATION OF BUSINESS RULES 1957
[RULE 3] - PORTAL Reference No:
BUSINESS REGISTRATION EB-A2020122100054

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
HAPPY FROSTBITE MEAL

* NAME SITI HASANAH BINTI MOHD RAZALI

* PERSONAL IDENTIFICATION NO. 940330106140 * COLOUR BLUE

* ADDRESS LOT 9780, JALAN 2/1 KAMPUNG MELAYU KEPONG

TOWN KUALA LUMPUR

POSTCODE 52100

STATE 14

* E-MAIL hasanah_razali@yahoo.com
* TELEPHONE 01115687423
FAX
 Form A
REGISTRATION OF BUSINESS RULES 1957
[RULE 3] - PORTAL Reference No:
BUSINESS REGISTRATION EB-A2020122100054

VERIFICATION BY OWNER/PARTNER(S)

NO. NAME IDENTITY CARD NO COLOUR SIGNATURE