You are on page 1of 8

Field

License Year
First Name
Last Name
Identity card no
Gender
BirthDate
Nationality
Address 1
Phone no
Email
Roles

Category
Team/Club
Emergency contact
Emergecy phone no.

IMPORTANT
Description
The year of the license
Official First Name of the person
Official Last Name of the person or Family name of the person
Identity card number of person (Format : 900404-04-5111)
Gender of the person (Format: M or F)
BirthDate of the person (Format : dd.mm.yyyy)
Nationality of the person (Format: UCI 3 letters code - Country code)
First line of the address
Phone number of the person (Format: country calling code and number : +60123456789
Contact email of the person
The roles can be : Rider, Commissaire, Doping Control Officer, Classifier, Technical Delegate, Federation Member, Team
Staff
BMX, MTB, Road, Track, Indoor Cycling, Para-cycling, General Member, Continental Team
Member of State Association (Affiliate), Continental Team or approved club by federation
Emergency contact full name
Emergency phone number

PLEASE PROVIDE PICTURE FOR EACH APLLICANT


Recommended field
Optional
These fields will in the future be used for data validation; please complete if known.
If you are able to quickly & efficiently complete this data, iyt would be helpful.
License Year First Name Last Name
2023 MUHAMMAD NASIR DHAIFULLAH
2023 MOHAMAD AMIRUL NIZAM MOHD AMIN
2023 NUHAMMAD KHAIRUL FAKHRI ABDUL KHODEL
2023 MOHD HAFIZ DANI MOHAMAD AMIN
2023 MUHAMMAD RIZQULLAH DZAKAWANG
2023 MOHAMMAD KHAIRI HAZWAN HAMDAN
Identity card no. Gender BirthDate Nationality
080808-12-1677 MALE 08.08.2008 MALAYSIA
050126-12-0055 MALE 26.01.2005 MALAYSIA
050123-12-0033 MALE 23.01.2005 MALAYSIA
071113-12-1131 MALE 13.11.2007 MALAYSIA
080303-12-1217 MALE 03.03.2008 MALAYSIA
030830-12-0309 MALE 30.08.2003 MALAYSIA
Roles Team/Club Address 1 Phone no.
RIDER LAHAD DATU DESA KENCANA,FELDA SAHABAT 3,LAHAD DATU 017-8236048
RIDER LAHAD DATU DESA KENCANA,FELDA SAHABAT 3,LAHAD DATU 0112-5209343
RIDER LAHAD DATU TAMAN SRI PERDANA LAHAD DATU 019-8607058
RIDER LAHAD DATU DESA KENCANA,FELDA SAHABAT 3,LAHAD DATU 0103914615
RIDER LAHAD DATU DESA KENCANA,FELDA SAHABAT 3,LAHAD DATU 0111-6439591
RIDER LAHAD DATU KAMPUNG TELISAI TUNGKU 016-4723410
Email Emergency Name Emergency Phone no.
Ndhaifullah08@gmail.com AZMIN ABDUL MAJID 012-7708605
mirulncemm@gmail.com MOHD AMIN RAHIM 0111-6002656
Khairulfakhri05@gmail.com ABDUL KHODEL 019-8607058
hafizdani07@icloud.com MOHD AMIN RAHIM 0111-6002656
Mrizqullahdzakwan@gmail.com
AWANG AMBAWAI 0135400669
khairihazwan03@gmail.com HAMDAN AMSANI 019-9024871

You might also like