Form A

REGISTRATION OF BUSINESS RULES 1957

[RULE 3] - PORTAL Reference No:
BUSINESS REGISTRATION EB-A2017110600561

(* Mandatory Field)

NAME APPROVAL NO. EB-A2017110600561

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 NORAZURA BINTI MOKHTAR

2. A) * DATE OF COMMENCEMENT OF BUSINESS 06/11/2017 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 N0 651
LALUAN KLEDANG 2D
TAMAN KLEDANG
TOWN SUNGAI SIPUT (U)

POSTCODE 31100

STATE PERAK

5. * TELEPHONE 01137676443 FAX

6. E-MAIL aswan_7915@yahoo.com.my

7. CORRESPONDENCE ADDRESS N0 651

(if different from above) LALUAN KLEDANG 2D
TAMAN KLEDANG

TOWN SUNGAI SIPUT (U)

POSTCODE 31100

STATE PERAK
 Form A
REGISTRATION OF BUSINESS RULES 1957
[RULE 3] - PORTAL Reference No:
BUSINESS REGISTRATION EB-A2017110600561

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

PERKHIDMATAN KATERING DAN MAKANAN BERMASAK ISLAM

NO BUSINESS TYPE (CODE) DESCRIPTION

56210 KATERING MAKANAN
1 (EVENT/FOOD CATERERS)

SUBMISSION DATE 06/11/2017

(dd/mm/yyyy)
 Form A
REGISTRATION OF BUSINESS RULES 1957
[RULE 3] - PORTAL Reference No:
BUSINESS REGISTRATION EB-A2017110600561

INFORMATION OF OWNERS (* Mandatory field)

1.*NAME OF OWNER NORAZURA BINTI MOKHTAR

2. *DATE OF BIRTH 02/07/1982
(dd/mm/yyyy)
3. *NATIONALITY MALAYSIAN
IF PERMANENT RESIDENT, STATE COUNTRY
OF ORIGIN
4. *PERSONAL OLD 5.*COLOUR BLUE
IDENTIFICATION
NO
MYKAD 820702086202
MYPR

PASSPORT

POLICE

ARMY

6.*SEX Female
7.*RACE MELAYU
8.*RESIDENTIAL ADDRESS NO 651,
LALUAN KLEDANG 2 D
TAMAN KLEDANG
9.*TOWN SUNGAI SIPUT (U)

10.*POSTCODE 31100

11.*STATE PERAK

12.TELEPHONE 01137676443 FAX

13.E-MAIL aswan_7915@yahoo.com.my
14.*OWNERSHIP SOLE PROPRIETORSHIP
SUBMISSION DATE 06/11/2017
(dd/mm/yyyy)
 Form A
REGISTRATION OF BUSINESS RULES 1957
[RULE 3] - PORTAL Reference No:
BUSINESS REGISTRATION EB-A2017110600561

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
NORAZURA BINTI MOKHTAR

* NAME NORAZURA BINTI MOKHTAR

* PERSONAL IDENTIFICATION NO. 820702086202 * COLOUR BLUE

* ADDRESS NO 651,
LALUAN KLEDANG 2 D
TAMAN KLEDANG
TOWN SUNGAI SIPUT (U)

POSTCODE 31100

STATE PERAK

* E-MAIL aswan_7915@yahoo.com.my
* TELEPHONE 01137676443
FAX
 Form A
REGISTRATION OF BUSINESS RULES 1957
[RULE 3] - PORTAL Reference No:
BUSINESS REGISTRATION EB-A2017110600561

VERIFICATION BY OWNER/PARTNER(S)

NO. NAME IDENTITY CARD NO COLOUR SIGNATURE

1 NORAZURA BINTI MOKHTAR 820702086202 BLUE aswan_7915@yahoo.com.
my