BSNeBiz Application Form

State State

State Selangor

Organization Information

Business Registration Number : Address : TINGKAT 16, WISMA EHSAN, BSN

CUN SELANGOR,
Organization Name : KELAB SUKAN DAN KEBAJIKAN PERSIARAN DATO' MENTERI,
SSDU SEKSYEN 14,
Office No : 0356500900

Fax Number : Postcode : 40000

Email : City : SHAH ALAM

Website : Country : MALAYSIA

State Selangor

Contact Person

Contact Person 1 : Contact Person 2 :

Contact Person's Name : MOHD YUSSOF NOR BIN Contact Person's Name : NURSHAZWANI BINTI YUSOFF
HASSAN
Contact Person's Identity 861003465597 Contact Person's Identity 910812105952
Card No : Card No :
Contact Person's Mobile 0179363667 Contact Person's Mobile 0123528587
Phone No : Phone No :
Contact Person's Office 0356500900 Contact Person's Office
Phone No : Phone No :
Contact Person's Email : yussof.hassan@ssdu.com.my Contact Person's Email : nurshazwani.yusoff@ssdu.com.my

Administrative Information

Customer Admin's Name : NURUL SYAMIMI BINTI ABD

WAHAB
Customer Admin's Identity 911118105244
Card No :
Customer Admin's Mobile 0146368486
Phone No :
Customer Admin's Office 0356500900
Phone No :
Customer Admin's Email : syamimi.wahab@ssdu.com.my

Customer Staff No :
 BSNeBiz Application Form

Account

Allow Services BSN Corporate Account

Y Online Payment

Y Bulk Payment

Y Auto Debit

Y Collection

Y KWSP

Employer EPF No

021115118

Contact Person

Contact Number

Y LHDN

HQ Employer No

Employer No

Y SOCSO

Employer No