R5 Pendaftaran Kontraktor Tempatan Kenaikan Gred
R5 Pendaftaran Kontraktor Tempatan Kenaikan Gred
R5 Pendaftaran Kontraktor Tempatan Kenaikan Gred
Lembaga Pembangunan
Industri Pembinaan Malaysia UNTUK KEGUNAAN PEJABAT
FOR OFFICE USE
CONSTRUCTION INDUSTRY DEVELOPMENT BOARD MALAYSIA
Ibu Pejabat CIDB, Tingkat 7, Grand Seasons Avenue, No. 72, Jalan Pahang, 53000 Kuala Lumpur.
P.O. Box. 12278, 50772 Kuala Lumpur. Tel: 03-2617 0200 • Fax: 03-2617 0220
h t t p : / / w w w. c i d b . g o v. m y
CIDB Wilayah Utara (Kedah) CIDB Wilayah Selatan (Johor) CIDB Wilayah Timur (Terengganu) CIDB Sabah CIDB Sarawak
Tel : 04-390 2448 Tel : 05-2423 488 Tel : 09-743 5311 Tel : 09-517 8953 / 8734 Tel : 089-777 841 / 777 842 Tel : 085-665 431
Fax : 04-390 7448 Fax : 05-2555 488 Fax : 09-744 4311 Fax : 09-517 8751 Fax : 089-777 842 Fax : 085-665 432
Fee Proses /Processing Fee : RM30.00 Harga Borang /Price of Form : RM5.00
A. Maklumat Pemohon BORANG UPP 1 / 2
Particulars of Applicant Bahagian Pembangunan
Personel Binaan
(Construction Manpower
Development Division)
No. Pendaftaran Perniagaan/Syarikat ...................................................................................................... Tingkat 7, Grand Seasons Avenue,
Registration No. Of Business/Company No. 72, Jalan Pahang, 53000 Kuala Lumpur,
P.O. Box. 12278, 50772 Kuala Lumpur.
Alamat berdaftar/registered address Alamat surat-menyurat
(Seperti dalam borang D/borang 44/Annual Returns) Correspondence address Tel : 603-4044 8808
(As stated in form D/form 44/Form 49) Fax : 603-4045 2808
...........................................................................
.......................................................................................... ...........................................................................
.......................................................................................... ........................................................................... MAKLUMAT PERSONEL BINAAN (CONSTRUCTION PERSONNEL INFORMATION)
...........................................................................
.......................................................................................... Kontraktor dikehendaki menyatakan maklumat semua kakitangan personel binaan di Syarikat di
........................................................................... bawah kategori Pengurus Tapak Binaan, Penyelia Tapak Binaan, Pekerja Mahir Binaan, Pekerja
.......................................................................................... ........................................................................... Separuh Mahir Binaan dan Pekerja Am Binaan dengan mengisi jadual di bawah. (Sila buat salinan, jika
.......................................................................................... perlu).
Poskod/Poscode: ................................................................
Tel: ....................................... Fax : ....................................
Contractors are required to declare the information regarding all construction personnel in the company
Poskod/Postcode: ............................................................
E-mail: ............................................................................... under the category of Construction Site Manager, Contruction Site Supervisor, Skilled Construction
Tel : ....................................Fax : .................................... Worker, Semi-skilled Construction Worker and General Construction Worker by filling up the following
Webpage: ..........................................................................
E-mail : ................................. table. (Please make copies, if required).
No. Pendaftaran
B. Gred, Kategori dan Pengkhususan Semasa Kategori / Tugas
Contoh: Pekerja Mahir Binaan/ Personel Binaan
CIDB (jika ada)
Current RegisterationGrade, Category and Specialization Bil. Nama No. K/P. (Baru & Lama) Alamat surat-menyurat Penerap Bata, Tukang Konkrit
CIDB Construction
No. Name atau No. Pasport Correspondence address Category /Task
I/C No. (New & Old) e.g.: Skilled Const. Worker/ Personnel Reg.
or Passport No. Bricklayer, Concretor No. (If any)
CE
ME 2.
2 7
H. Pengakuan E. Maklumat Sumber Kewangan (TIDAK PERLU UNTUK TAMBAH KATEGORI/PENGKHUSUSAN)
Declaration Particulars of Financial Resources (NOT REQUIRED FOR ADDITIONAL CATEGORY/SPECIALIZATION)
Saya/ Kami mengaku dan mengesahkan bahawa maklumat yang diberi dan segala salinan Lengkapkan butir-butir di bahagian
dokumen yang disertakan bersama borang permohonan ini adalah benar. Saya/ Kami sedar dan Complete details in section
memahami bahawa jika maklumat dan dokumen yang dikemukakan adalah palsu maka
permohonan saya/ kami akan ditolak dan sebarang kelulusan yang telah diberikan akan (i) - Bagi firma pemilik tunggal atau perkongsian ATAU
dibatalkan. For sole proprietorship or partnership firm OR
Saya/Kami dengan ini memberikan kebenaran kepada pihak LPIPM untuk mendapatkan apa-apa (ii) - Bagi syarikat sendirian berhad/syarikat berhad/koperasi dan lain-lain
maklumat lanjut dari bank/ institusi kewangan pada bila-bila masa. For private limited company/public company/cooperative and others
I / We declare and confirm that the information given and photostated copies of documents (i) FIRMA PEMILIKAN TUNGGAL ATAU PERKONGSIAN
submitted together with this application are authentic. I am/ We are aware and understand that SOLE PROPRIETORSHIP OR PARTNERSHIP FIRM
any information and documents submitted found to be false shall cause my/ our application to be
rejected and any approval granted shall be revoked. Modal terkumpul/Net capital worth RM
I / We hereby authorize CIDB to request any further information required from myl our 1. Baki penyata akaun bank untuk tiga bulan yang terkini
bank(s)/ financial institution(s) at any time. Balance of the latest three months bank account statements
a) RM ...................................... }
b) RM ......................................} Jumlah (Total ) ÷ 3 =
Tandatangan: ............................................................... c) RM ......................................}
(Signature) 2. Amaun kemudahan overdraf
Amount of overdraft facilities
Nama : .......................................................................... 3. Simpanan tetap (termasuk simpanan tetap pemilik tunggal atau setiap
(Name) rakan kongsi) yang tidak dicagar pada mana-mana bank atau institusi
kewangan
Jawatan: ........................................................................ Fixed deposit(s) (including deposit(s) of sole proprietor or each partner)
(Designation) which is/are not charged to any bank or financial institution
4. Baki di akaun simpanan (termasuk akaun simpanan pemilik tunggal atau
No. K/P./No. Pasport: ....................................................... setiap rakan kongsi)
(I/C No./Passport No) Balance in savings account (including savings account of sole proprietor
or each partner)
Tarikh : ........................................................................... 5. Lain-lain (Saham ASB/ASN dll.) Others (ASB/ASN Shares etc.)
(Date)
Jumlah/Total
Cop Syarikat / Firma (ii) SYARIKAT SENDIRIAN BERHAD/SYARIKAT BERHAD/KOPERASI DAN LAIN-LAIN
Firm / Company Chop PRIVATE LIMITED COMPANY/PUBLIC COMPANY/COOPERATIVE AND OTHERS
Jumlah/Total
Nilai Syarikat/Networth RM
6 3
F. Maklumat Pemilik/Rakan Kongsi/Pengarah/Ahli Lembaga dan Personel Teknikal yang Digaji Sepenuh Masa
Particulars of the Owner/Partner(s) Director(s)/Board members(s) and full Time Technical Personnel
4
*
Sila kemukakan salinan kad pengenalan/Please submit copy of identity card.
@ Sila kemukakan salinan sijil berkaitan. Jurutera Arkitek dan Jurukur Bahan hendaklah mengemukakan salinan pendaftaran dengan Lembaga masing-masing.
Please submit a copy the relevant certificate. Engineers, Architects and Quantity Surveyors should present a copy registration with their respective Boards.
# Sila kemukakan senarai pengalaman yang menyenaraikan jenis dan saiz projek yang dikawalselia atau diuruskan bersama dengan surat sokongan dari majikan seperti
surat tawaran jawatan atau seumpamanya.
Please submit resume Iisting type and size or projects supervised of managed, together with supporting documents from employer(s) such as employment letters and
likewise
5
*
4
*
Sila kemukakan salinan kad pengenalan/Please submit copy of identity card.
@ Sila kemukakan salinan sijil berkaitan. Jurutera Arkitek dan Jurukur Bahan hendaklah mengemukakan salinan pendaftaran dengan Lembaga masing-masing.
Please submit a copy the relevant certificate. Engineers, Architects and Quantity Surveyors should present a copy registration with their respective Boards.
# Sila kemukakan senarai pengalaman yang menyenaraikan jenis dan saiz projek yang dikawalselia atau diuruskan bersama dengan surat sokongan dari majikan seperti
surat tawaran jawatan atau seumpamanya.
Please submit resume Iisting type and size or projects supervised of managed, together with supporting documents from employer(s) such as employment letters and
likewise
5
*
I/we solemly declare and confirm that the information given and copies of
documents submitted together with this application are true and correct.
Saya/kami dengan ini mengesahkan bahawa Saya / Kami akan mematuhi semua
kehendak dan ketetapan yang dinyatakan dalam Kod Etika Kontraktor (“Kod
Etika”). Saya/kami juga memahami bahawa jika saya/kami gagal mematuhi Kod
Etika ini, saya/kami boleh dikenakan tindakan tatatertib oleh CIDB.
I / We hereby certify that I / we will comply with all requirements and stipulations
specified in the Code of Ethics for Contractors ("Code of Ethics"). I / we also
understand that if I / we fail to comply with the Code of Ethics, I / we may be
subject to disciplinary action by CIDB.
Cop Syarikat/Firma
(firm/company chop)
Tandatangan:……………………………………
(Signature)
Nama:……………………………………………..
(Name)
Jawatan:………………………………………….
(Designation)
Tarikh:……………………………………………..
(Date)
5
6
A. Maklumat Pemohon BORANG UPP 1 / 2
Particulars of Applicant Bahagian Pembangunan
Personel Binaan
(Construction Manpower
Development Division)
No. Pendaftaran Perniagaan/Syarikat ...................................................................................................... Tingkat 7, Grand Seasons Avenue,
Registration No. Of Business/Company No. 72, Jalan Pahang, 53000 Kuala Lumpur,
P.O. Box. 12278, 50772 Kuala Lumpur.
Alamat berdaftar/registered address Alamat surat-menyurat
(Seperti dalam borang D/borang 44/Annual Returns) Correspondence address Tel : 603-4044 8808
(As stated in form D/form 44/Form 49) Fax : 603-4045 2808
...........................................................................
.......................................................................................... ...........................................................................
.......................................................................................... ........................................................................... MAKLUMAT PERSONEL BINAAN (CONSTRUCTION PERSONNEL INFORMATION)
...........................................................................
.......................................................................................... Kontraktor dikehendaki menyatakan maklumat semua kakitangan personel binaan di Syarikat di
........................................................................... bawah kategori Pengurus Tapak Binaan, Penyelia Tapak Binaan, Pekerja Mahir Binaan, Pekerja
.......................................................................................... ........................................................................... Separuh Mahir Binaan dan Pekerja Am Binaan dengan mengisi jadual di bawah. (Sila buat salinan, jika
.......................................................................................... perlu).
Poskod/Poscode: ................................................................
Tel: ....................................... Fax : ....................................
Contractors are required to declare the information regarding all construction personnel in the company
Poskod/Postcode: ............................................................
E-mail: ............................................................................... under the category of Construction Site Manager, Contruction Site Supervisor, Skilled Construction
Tel : ....................................Fax : .................................... Worker, Semi-skilled Construction Worker and General Construction Worker by filling up the following
Webpage: ..........................................................................
E-mail : ................................. table. (Please make copies, if required).
No. Pendaftaran
B. Gred, Kategori dan Pengkhususan Semasa Kategori / Tugas
Contoh: Pekerja Mahir Binaan/ Personel Binaan
CIDB (jika ada)
Current RegisterationGrade, Category and Specialization Bil. Nama No. K/P. (Baru & Lama) Alamat surat-menyurat Penerap Bata, Tukang Konkrit
CIDB Construction
No. Name atau No. Pasport Correspondence address Category /Task
I/C No. (New & Old) e.g.: Skilled Const. Worker/ Personnel Reg.
or Passport No. Bricklayer, Concretor No. (If any)
CE
ME 2.
2 7
CONSTRUCTION INDUSTRY
DEVELOPMENT BOARD MALAYSIA
HEAD OFFICE
Level 7, Grand Seasons Avenue,
No.72, Jalan Pahang
53000 Kuala Lumpur
MALAYSIA
Tel : 6 03-2617 0200
Fax : 6 03-2617 0220
CIDB Pahang
A1, Ground 1st, 2nd & 3rd Floor,
Jalan Seri Kuantan 2
Sri Kuantan Square
25050 Kuantan, Pahang
Tel : 09-517 8734/8953
Fax : 09- 517 8751