Form 1 .pdf

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Original filename: Form 1.pdf
Title: BORANG 1
Author: M P S M

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SCHEDULE
FORMS
(Regulation 3)
PEMBANGUNAN SUMBER MANUSIA BERHAD ACT 2001
PEMBANGUNAN SUMBER MANUSIA BERHAD
(REGISTRATION OF EMPLOYERS AND PAYMENT OF LEVY) REGULATIONS 2001
FORM 1
(Regulation 4)
REGISTRATION OF EMPLOYER

For Official Use

1. Employer’s Name

Employer’s Code No.

2. Correspondence Address

Address

Town

Batch No.
Postcode

P.O. Box No.
Mail Bag No.

3. (a) Telephone No.

Type of Transaction

0 1

(b) Facsimile No.

(c) E-Mail Address ........................................................................................................................................................

4. (a) Business or Company Registration No.
Please attach a copy of the Certificate of
Registration of Business or Incorporation.
(b)

Year business or company was registered.

(c)

Type of ownership (Please tick (9) in the appropriate box).

i)

Sole Proprietorship

iv) Public Limited Company

ii)

Partnership

v)

Others.................................................................
Please specify

iii) Private Limited Company

(d) Name and full address of location of enterprise.

(e) Date of commencement of enterprise.
Industry Code
(f) Type of industry..........................................................................................................................................................

5. Employer’s EPF No.: ....................................................................................................................................................
6. Employer’s SOCSO No.: ..............................................................................................................................................

7. Current paid-up capital

™ RM ..............................................

RM

8. (a) Total number of employees (+) as at date in Item 12

(b) Date of attaining the number of employees (+)
as specified under the First Schedule to the Act.

Date of liability for payment of levy under the Act.

9. (a) Total number of employees (+) in the previous month.

(b) Total amount of wages paid to employees
(+) in the previous month.

z

RM

10. Details of proprietor/business partners/managing director.
(Please use additional sheet(s) if space provided is insufficient).
(a) Name

(b) Identity Card/Passport No.
(c) Address

œ 11. I agree / disagree * to register under Pembangunan Sumber Manusia Berhad Act 2001.

I hereby declare that the information given above is true and complete.

12. Date........................................................

...................................................................................................
Signature of employer/representative of employer*
Date of Registration

...................................................................
Employer’s official stamp

Name .........................................................................................
Capital letters

Designation ...............................................................................

Note :
1) (™) If your paid-up capital is RM2,750,000 please state RM2.750 million only.
2) (+) “Employee” refers to a citizen of Malaysia.
3) (*) Delete where inapplicable.

Process by :

___________________________________
œ REMINDER :

Item 11 is only for employers with 10 - 49 employees and a paid-up capital of less than
RM2.5 million in the manufacturing sector only.
Approved by :

__________________________________


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