Form A

REGISTRATION OF BUSINESS RULES 1957

[RULE 3] - PORTAL Reference No:
BUSINESS REGISTRATION EB-A2022080401733

(* Mandatory Field)

NAME APPROVAL NO. EB-A2022080401733

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 RAMLI BIN ZAKARIA

2. A) * DATE OF COMMENCEMENT OF BUSINESS 04/08/2022 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 LOT 8922, JALAN NAKHODA KIRI 3
KAMPUNG NAKHODA

TOWN BATU CAVES

POSTCODE 68100

STATE SELANGOR

5. * TELEPHONE 0172947257 FAX

6. E-MAIL

7. CORRESPONDENCE ADDRESS LOT 8922, JALAN NAKHODA KIRI 3

(if different from above) KAMPUNG NAKHODA

TOWN BATU CAVES

POSTCODE 68100

STATE SELANGOR
 Form A
REGISTRATION OF BUSINESS RULES 1957
[RULE 3] - PORTAL Reference No:
BUSINESS REGISTRATION EB-A2022080401733

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

PENYEDIAAN MAKANAN DAN MINUMAN

SERTA ALATAN KESIHATAN

NO BUSINESS TYPE (CODE) DESCRIPTION

56106 GERAI/PENJAJA MAKANAN
1 (FOOD STALLS/HAWKERS)

56107 MAKANAN DAN MINUMAN, PENYEDIAAN MAKANAN DAN

2 MINUMAN DI DALAM GERAI/PENJAJA.
(FOOD OR BEVERAGE, FOOD AND BEVERAGE PREPARATION IN
MARKET STALLS/HAWKERS)

56210 KATERING MAKANAN

3 (EVENT/FOOD CATERERS)

56290 AKTIVITI PERKHIDMATAN MAKANAN LAIN

4 (OTHER FOOD SERVICE ACTIVITIES)

23102 PEMBUATAN BARANGAN KACA MAKMAL, BARANGAN KESIHATAN

5 ATAU FARMASEUTIKAL
(MANUFACTURE OF LABORATORY, HYGIENIC OR PHARMACEUTICAL
GLASSWARE )

SUBMISSION DATE 04/08/2022

(dd/mm/yyyy)
 Form A
REGISTRATION OF BUSINESS RULES 1957
[RULE 3] - PORTAL Reference No:
BUSINESS REGISTRATION EB-A2022080401733

INFORMATION OF OWNERS (* Mandatory field)

1.*NAME OF OWNER RAMLI BIN ZAKARIA

2. *DATE OF BIRTH 31/12/1969
(dd/mm/yyyy)
3. *NATIONALITY MALAYSIAN
IF PERMANENT RESIDENT, STATE
COUNTRY OF ORIGIN
4. *PERSONAL OLD 5.*COLOUR BLUE
IDENTIFICATION
NO
MYKAD 691231115039
MYPR

PASSPORT

POLICE

ARMY

6.*SEX Male
7.*RACE MELAYU
8.*RESIDENTIAL ADDRESS LOT 8922, JALAN NAKHODA KIRI 3
KAMPUNG NAKHODA

9.*TOWN BATU CAVES

10.*POSTCODE 68100

11.*STATE SELANGOR

12.TELEPHONE 0172947257 FAX

13.E-MAIL ramli312@gmail.com
14.*OWNERSHIP SOLE PROPRIETORSHIP
SUBMISSION DATE 04/08/2022
(dd/mm/yyyy)
 Form A
REGISTRATION OF BUSINESS RULES 1957
[RULE 3] - PORTAL Reference No:
BUSINESS REGISTRATION EB-A2022080401733

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
RAMLI BIN ZAKARIA

* NAME RAMLI BIN ZAKARIA

* PERSONAL IDENTIFICATION NO. 691231115039 * COLOUR BLUE

* ADDRESS LOT 8922, JALAN NAKHODA KIRI 3

KAMPUNG NAKHODA

TOWN BATU CAVES

POSTCODE 68100

STATE SELANGOR

* E-MAIL ramli312@gmail.com
* TELEPHONE 0172947257
FAX
 Form A
REGISTRATION OF BUSINESS RULES 1957
[RULE 3] - PORTAL Reference No:
BUSINESS REGISTRATION EB-A2022080401733

VERIFICATION BY OWNER/PARTNER(S)

NO. NAME IDENTITY CARD NO COLOUR SIGNATURE

1 RAMLI BIN ZAKARIA 691231115039 BLUE ramli312@gmail.com