Form A

REGISTRATION OF BUSINESS RULES 1957

[RULE 3] - PORTAL Reference No:
BUSINESS REGISTRATION EB-A2023030800423

(* Mandatory Field)

NAME APPROVAL NO. EB-A2023030800423

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 MASLIANA BINTI MISDI

2. A) * DATE OF COMMENCEMENT OF BUSINESS 05/02/2023 B) * REGISTRATION 1 YEARS

(dd/mm/yyyy) PERIOD
3. * PARTNERSHIP AGREEMENT NO DATE
(If yes, upload the copy of agreement) (dd/mm/yyyy)
4. ADDRESS OF PRINCIPAL PLACE OF BUSINESS NO 19 TAMAN TANJUNG MINYAK PERDANA
JALAN ZUHAL 5

TOWN MELAKA

POSTCODE 76450

STATE MELAKA

5. * TELEPHONE 0172673160 FAX

6. E-MAIL masliana9701@gmail.com

7. CORRESPONDENCE ADDRESS NO 19 TAMAN TANJUNG MINYAK PERDANA

(if different from above) JALAN ZUHAL 5

TOWN MELAKA

POSTCODE 76450

STATE MELAKA
 Form A
REGISTRATION OF BUSINESS RULES 1957
[RULE 3] - PORTAL Reference No:
BUSINESS REGISTRATION EB-A2023030800423

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

KEDAI PELBAGAI JENIS PAKAIAN SERTA AKSESORI PAKAIAN

NO BUSINESS TYPE (CODE) DESCRIPTION

47820 JUALAN RUNCIT TEKSTIL, BAJU DAN KASUT DI GERAI ATAU PASAR
1 ATAU BUTIK
(RETAIL SALE OF TEXTILES, CLOTHING AND FOOTWEAR VIA STALLS
OR MARKETS OR BOUTIQUE)

SUBMISSION DATE 08/03/2023

(dd/mm/yyyy)
 Form A
REGISTRATION OF BUSINESS RULES 1957
[RULE 3] - PORTAL Reference No:
BUSINESS REGISTRATION EB-A2023030800423

INFORMATION OF OWNERS (* Mandatory field)

1.*NAME OF OWNER MASLIANA BINTI MISDI

2. *DATE OF BIRTH 25/01/1997
(dd/mm/yyyy)
3. *NATIONALITY MALAYSIAN
IF PERMANENT RESIDENT, STATE
COUNTRY OF ORIGIN
4. *PERSONAL OLD 5.*COLOUR BLUE
IDENTIFICATION
NO
MYKAD 970125045008
MYPR

PASSPORT

POLICE

ARMY

6.*SEX Female
7.*RACE MELAYU
8.*RESIDENTIAL ADDRESS NO 19 TAMAN TANJUNG MINYAK PERDANA
JALAN ZUHAL 5

9.*TOWN MELAKA

10.*POSTCODE 76450

11.*STATE MELAKA

12.TELEPHONE 0172673160 FAX

13.E-MAIL masliana9701@gmail.com
14.*OWNERSHIP SOLE PROPRIETORSHIP
SUBMISSION DATE 08/03/2023
(dd/mm/yyyy)
 Form A
REGISTRATION OF BUSINESS RULES 1957
[RULE 3] - PORTAL Reference No:
BUSINESS REGISTRATION EB-A2023030800423

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

I/We confirm the accuracy of all the statements made in the form lodged persuant to the Rules and section 22A of the
Registration of Businesses Act 1956 and declare that I/We am/are the owner/partner(s) of the business the name of
which is
MASLIANA BINTI MISDI

* NAME MASLIANA BINTI MISDI

* PERSONAL IDENTIFICATION NO. 970125045008 * COLOUR BLUE

* ADDRESS NO 19 TAMAN TANJUNG MINYAK PERDANA

JALAN ZUHAL 5

TOWN MELAKA

POSTCODE 76450

STATE MELAKA

* E-MAIL masliana9701@gmail.com
* TELEPHONE 0172673160
FAX
 Form A
REGISTRATION OF BUSINESS RULES 1957
[RULE 3] - PORTAL Reference No:
BUSINESS REGISTRATION EB-A2023030800423

VERIFICATION BY OWNER/PARTNER(S)

NO. NAME IDENTITY CARD NO COLOUR SIGNATURE

1 MASLIANA BINTI MISDI 970125045008 BLUE masliana9701@gmail.com