PERMANENT PASS FOR CONTRACT WORKERS

APPLICATION FORM
APPLICANT DETAILS

Name (Per IC/Passport) Nationality

NRIC No I Passpmt No Exp Date (Passport): ...................................
Work Visa/Permit No Exp Date (Permit): ......................................
Date of Birth Place of Birth : ............................ .................
Address

H IP Number : ........................................... .............. Exp Date (CIDB): ... ...... ..... . . ..............

COMPANY DETAILS

Company
Address
Tel No (office): ...................................... (HP) .................................................. Fax No : .................................
PURPOSE OF APPLICATION: ..............................................................................................................................................

COMPANY DECLARATION

We declare that the above-named person is our employee and has satisfied all requirements to enter a contract of
employment under the country's labour laws or any applicable laws.

Validity of Photo Badge: .......................Days/Months/Year & Work Permit: Valid date/year from ..............to ................
Applicant Work Location: ........................................................................................................................................................ ·
Hartalega Manager/Person in Charge & Phone number: . . . .. . ............ . ... . . ......................................... . . ......
Contractor Manager/Person in Charge & Phone number : .................................................................................................

Employer's Signature : ...........................................

Naine . ............................ ............... (Company Chop)

FOR HARTALEGA SECURITY USE ONLY

The application document has been verified true I false copies by Executive of Haitalega Security Depaiiment.
The above has been APPROVED I REJECTED

(Name & Signature) ID:

PASS NO
SECURITY CODE NO
EXPIRY DATE

(Note: Contractor Badge/Pass is the property of the company and must be returned to the Security Department upon expiry .)