Nama Firma / Syarikat: .........................................................................................

Name of Firm / Company:

No. Pendaftaran CIDB:
CIDB Registration No.:
Tarikh Luput Pendaftaran CIDB:
CIDB Registration Expiry Date:
UNTUK KEGUNAAN PEJABAT
FOR OFFICE USE
Tarikh Terima: .......................................... Jumlah Fee Proses : .............................
No. Permohonan: ..................................... No. Resit: .............................................
Gred Dipohon:: ............................................. No. Fail: .................................................
Nama Pegawai: .............................................................................................................
Fee Proses /Processing Fee : RM30.00
Harga Borang /Price of Form : RM5.00
M A L A Y S I A
Lembaga Pembangunan
Industri Pembinaan Malaysia
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
ht t p: / / www. ci db. gov. my
Head Office / Ibu Pejabat CIDB
Tingkat 7, Grand Seasons Avenue, No.72, Jalan Pahang, 53000 Kuala Lumpur. P.O. Box.12278, 50772 Kuala Lumpur.
Lembaga Pembangunan Industri Pembinaan Malaysia
CONSTRUCTION INDUSTRY DEVELOPMENT BOARD MALAYSIA
Pendaftaran Kontraktor Tempatan
Permohonan Kenaikan Gred/Tambah Kategori/
Tambah Pengkhususan
Registration of Local Contractor
Application for Upgrading/Additional Category/Additional
Specialization
Borang CIDB R1/95(Pin.2/01) / Form CIDB R1/95 (Rev.2/01)
No. Siri / Serial No: ...........................................................................
R5
CIDB Regional Offices / Pejabat Wilayah CIDB:
CIDB Wilayah Utara (Kedah)
Lot 1-4, Tingkat 11,
City Plaza,
Jalan Tunku Ibrahim,
05000 Alor Setar,
Kedah.
Tel : 04-733 1243
Fax : 04-733 1175
CIDB Wilayah Selatan (Johor)
Lot 2067,Batu 3,
Jalan Tampoi,
81200 Johor Bahru,
Johor.
Tel : 07-234 4808
Fax : 07-234 4807
CIDB Wilayah Timur (Terengganu)
Tingkat 7,
Menara Yayasan Islam Terengganu,
Jalan Sultan Omar,
20300 Kuala Terengganu,
Terengganu.
Tel : 09-624 5311
Fax : 09-623 8973
CIDB Sabah
Lot EG. 11, Tingkat Bawah,
Block E, Bangunan KUW ASA,
88100 Kota Kinabalu,
Sabah.
Tel : 088-235 060
Fax : 088-242 481
CIDB Sarawak
Tingkat 1, Blok A, Kompleks CIDB,
Jalan Sultan Tengah,
93050 Kuching,
Sarawak.
Tel : 082-445 833 / 446 833
Fax : 082-447 833
Pejabat Kecil CIDB
Negeri Pulau Pinang
Lot 9.01, Tingkat 9, Bangunan KWSP,
No. 3009 Of f Lebuh Tenggiri 2,
Bandar Seberang Jaya, 13700
Seberang Jaya,
Pulau Pinang.
Tel : 04-390 2448
Fax : 04-390 7448
Pejabat Kecil CIDB
Negeri Perak
Lot 5.02, Tingkat 5,
Bangunan KWSP,
Jalan Greentown,
30450 Ipoh,
Perak
Tel : 05-2423 488
Fax : 05-2555 488
Pejabat Kecil CIDB
Negeri Kelantan
No.U7.2, Tingkat 7,
Menara Perbadanan,
Jalan Tengku Petra, Semerak,
15000 Kota Bharu,
Kelantan.
Tel : 09-743 5311
Fax : 09-744 4311
Pejabat Kecil CIDB
Negeri Pahang
Wisma Kontraktor Melayu Pahang,
Tingkat Bawah, B246 & 248,
Jalan Dato Lim Hoe Lek,
25200 Kuantan,
Pahang.
Tel : 09-517 8953 / 8734
Fax : 09-517 8751
Pejabat Kecil CIDB
Tawau
TB 306, Tingkat 2, Blok 35,
Kompleks Perdagangan Fajar,
Jalan Hj. Karim, Beg Berkunci No. 7,
91009 Tawau,
Sabah.
Tel : 089-777 841 / 777 842
Fax : 089-777 842
Pejabat Kecil CIDB
Miri
Kompleks Perdagangan Saberkas,
Jalan Miri-Lutong,
98000 Miri,
Sarawak.
Tel : 085-665 431
Fax : 085-665 432
CIDB State Of Fices / Pejabat Negeri CIDB:
Bil.
No.
Nama
Name
Alamat surat-menyurat
Correspondence address
No. K/P. (Baru & Lama)
atau No. Pasport
I/C No. (New & Old)
or Passport No.
No. Pendaftaran
Personel Binaan
CIDB (jika ada)
CIDB Construction
Personnel Reg.
No. (If any)
Kategori / Tugas
Contoh: Pekerja Mahir Binaan/
Penerap Bata, Tukang Konkrit
Category /Task
e.g.: Skilled Const. Worker/
Bricklayer, Concretor
1.
2.
3.
4.
5.
2 7
D. Persijilan MS ISO 9002: (Tanda salah satu yang berkaitan)
MS ISO 9002 Certi fi cati on: (Mark whichever applicable)

C. Kenaikan Gred dan/atau Tambah Kategori dan/atau Tambah Pengkhususan Dipohon

(Sila rujuk buku panduan sebelum mengisi bahagian ini)
Upgrading and/or Additional Category and/or Additional Specialization Applied For
(Please refer the guide book before completing this section)
B
CE
ME
B
CE
ME
B. Gred, Kategori dan Pengkhususan Semasa
Current RegisterationGrade, Category and Specialization
A. Maklumat Pemohon
Particulars of Applicant
No. Pendaftaran Perniagaan/Syarikat ......................................................................................................
Registration No. Of Business/Company
Alamat berdaftar/registered address Alamat surat-menyurat
(Seperti dalam borang D/borang 44/Annual Returns) Correspondence address
(As stated in form D/form 44/Form 49)
...........................................................................
...........................................................................
...........................................................................
...........................................................................
...........................................................................
...........................................................................
Poskod/Poscode: ................................................................
Tel: ....................................... Fax : ....................................
E-mail: ...............................................................................
Webpage: ..........................................................................
..........................................................................................
..........................................................................................
..........................................................................................
..........................................................................................
..........................................................................................
Poskod/Postcode: ............................................................
Tel : ....................................Fax : ....................................
E-mail : .................................
a) Ada b) Ti ada c) Lai n-l ai n: .........................................................................................................
Yes No Others
(Si l a Kemukakan satu sal i nan si j i l )
(Please submit a copy of certificate)
Gred
Grade
Kategori
Category
Kod Pengkhususan
Specialization Code
Gred
Grade
Kategori
Category
Kod Pengkhususan
Specialization Code
BORANG UPP 1 / 2
Bahagian Pembangunan
Personel Binaan
(Construction Manpower
Development Division)
Tingkat 7, Grand Seasons Avenue,
No. 72, Jalan Pahang, 53000 Kuala Lumpur,
P.O. Box. 12278, 50772 Kuala Lumpur.
Tel : 603-4044 8808
Fax : 603-4045 2808
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).
Contractors are required to declare the information regarding all construction personnel in the company
under the category of Construction Site Manager, Contruction Site Supervisor, Skilled Construction
Worker, Semi-skilled Construction Worker and General Construction Worker by filling up the following
table. (Please make copies, if required).
MAKLUMAT PERSONEL BINAAN (CONSTRUCTION PERSONNEL INFORMATION)
E. Maklumat Sumber Kewangan (TIDAK PERLU UNTUK TAMBAH KATEGORI/PENGKHUSUSAN)
Particulars of Financial Resources (NOT REQUIRED FOR ADDITIONAL CATEGORY/SPECIALIZATION)
Lengkapkan butir-butir di bahagian
Compl ete detai l s i n secti on
Modal terkumpul/Net capital worth
RM
RM
RM
Modal Saham/Share capital
3 6
Tandatangan: ...............................................................
(Signature)
Nama : ..........................................................................
(Name)
Jawatan: ........................................................................
(Designation)
No. K/P./No. Pasport: .......................................................
(I/C No./Passport No)
Tarikh : ...........................................................................
(Date)
Cop Syarikat / Firma
Firm / Company Chop
H. Pengakuan
Declaration
(i) - Bagi firma pemilik tunggal atau perkongsian ATAU
For sole proprietorship or partnership firm OR
(ii) - Bagi syarikat sendirian berhad/syarikat berhad/koperasi dan lain-lain
For private limited company/public company/cooperative and others
(i) FIRMA PEMILIKAN TUNGGAL ATAU PERKONGSIAN
SOLE PROPRIETORSHIP OR PARTNERSHIP FIRM
(ii) SYARIKAT SENDIRIAN BERHAD/SYARIKAT BERHAD/KOPERASI DAN LAIN-LAIN
PRIVATE LIMITED COMPANY/PUBLIC COMPANY/COOPERATIVE AND OTHERS
Saya/ Kami mengaku dan mengesahkan bahawa maklumat yang diberi dan segala salinan
dokumen yang disertakan bersama borang permohonan ini adalah benar. Saya/ Kami sedar dan
memahami bahawa jika maklumat dan dokumen yang dikemukakan adalah palsu maka
permohonan saya/ kami akan ditolak dan sebarang kelulusan yang telah diberikan akan
dibatalkan.
Saya/Kami dengan ini memberikan kebenaran kepada pihak LPIPM untuk mendapatkan apa-apa
maklumat lanjut dari bank/ institusi kewangan pada bila-bila masa.
I / We declare and confirm that the information given and photostated copies of documents
submitted together with this application are authentic. I am/ We are aware and understand that
any information and documents submitted found to be false shall cause my/ our application to be
rejected and any approval granted shall be revoked.
I / We hereby authorize CIDB to request any further information required from myl our
bank(s)/ financial institution(s) at any time.
1. Baki penyata akaun bank untuk tiga bulan yang terkini
Balance of the latest three months bank account statements

a) RM ...................................... }
b) RM ......................................} Jumlah (Total ) 3 =
c) RM ......................................}
2. Amaun kemudahan overdraf
Amount of overdraft facilities
3. Simpanan tetap (termasuk simpanan tetap pemilik tunggal atau setiap
rakan kongsi) yang tidak dicagar pada mana-mana bank atau institusi
kewangan
Fixed deposit(s) (including deposit(s) of sole proprietor or each partner)
which is/are not charged to any bank or financial institution
4. Baki di akaun simpanan (termasuk akaun simpanan pemilik tunggal atau
setiap rakan kongsi)
Balance in savings account (including savings account of sole proprietor
or each partner)
5. Lain-lain (Saham ASB/ASN dll.) Others (ASB/ASN Shares etc.)
Jumlah/Total

1. Jumlah modal berbayar/saham anggota dimiliki oleh badan/individu tempatan
Total paid-up capital/shares of members owned by local bodies/individual(s)
2. Jumlah modal berbayar dimiliki oleh badan/individu asing
Total paid-up capital owned by foreign bodies/individual(s)
Jumlah/Total
1. Jumlah Aset tolak Jumlah Liabiliti berdasarkan lembaran imbangan terkini
Total Assets less Total Liabilities based on latest balance sheet
Nilai Syarikat/Networth
4
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Pengakuan
Declaration

Saya/kami dengan sesungguhnya mengakui dan mengesahkan bahawa
maklumat yang diberikan di dalam borang permohonan ini dan segala salinan
dokumen yang disertakan bersamanya adalah benar.

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)

No. K/P./No. Pasport:........................................
(I/C No./ Pasport No.)

Tarikh:..
(Date)
6
Bil.
No.
Nama
Name
Alamat surat-menyurat
Correspondence address
No. K/P. (Baru & Lama)
atau No. Pasport
I/C No. (New & Old)
or Passport No.
No. Pendaftaran
Personel Binaan
CIDB (jika ada)
CIDB Construction
Personnel Reg.
No. (If any)
Kategori / Tugas
Contoh: Pekerja Mahir Binaan/
Penerap Bata, Tukang Konkrit
Category /Task
e.g.: Skilled Const. Worker/
Bricklayer, Concretor
1.
2.
3.
4.
5.
2 7
D. Persijilan MS ISO 9002: (Tanda salah satu yang berkaitan)
MS ISO 9002 Certi fi cati on: (Mark whichever applicable)

C. Kenaikan Gred dan/atau Tambah Kategori dan/atau Tambah Pengkhususan Dipohon

(Sila rujuk buku panduan sebelum mengisi bahagian ini)
Upgrading and/or Additional Category and/or Additional Specialization Applied For
(Please refer the guide book before completing this section)
B
CE
ME
B
CE
ME
B. Gred, Kategori dan Pengkhususan Semasa
Current RegisterationGrade, Category and Specialization
A. Maklumat Pemohon
Particulars of Applicant
No. Pendaftaran Perniagaan/Syarikat ......................................................................................................
Registration No. Of Business/Company
Alamat berdaftar/registered address Alamat surat-menyurat
(Seperti dalam borang D/borang 44/Annual Returns) Correspondence address
(As stated in form D/form 44/Form 49)
...........................................................................
...........................................................................
...........................................................................
...........................................................................
...........................................................................
...........................................................................
Poskod/Poscode: ................................................................
Tel: ....................................... Fax : ....................................
E-mail: ...............................................................................
Webpage: ..........................................................................
..........................................................................................
..........................................................................................
..........................................................................................
..........................................................................................
..........................................................................................
Poskod/Postcode: ............................................................
Tel : ....................................Fax : ....................................
E-mail : .................................
a) Ada b) Ti ada c) Lai n-l ai n: .........................................................................................................
Yes No Others
(Si l a Kemukakan satu sal i nan si j i l )
(Please submit a copy of certificate)
Gred
Grade
Kategori
Category
Kod Pengkhususan
Specialization Code
Gred
Grade
Kategori
Category
Kod Pengkhususan
Specialization Code
BORANG UPP 1 / 2
Bahagian Pembangunan
Personel Binaan
(Construction Manpower
Development Division)
Tingkat 7, Grand Seasons Avenue,
No. 72, Jalan Pahang, 53000 Kuala Lumpur,
P.O. Box. 12278, 50772 Kuala Lumpur.
Tel : 603-4044 8808
Fax : 603-4045 2808
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).
Contractors are required to declare the information regarding all construction personnel in the company
under the category of Construction Site Manager, Contruction Site Supervisor, Skilled Construction
Worker, Semi-skilled Construction Worker and General Construction Worker by filling up the following
table. (Please make copies, if required).
MAKLUMAT PERSONEL BINAAN (CONSTRUCTION PERSONNEL INFORMATION)

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 Wilayah Persekutuan CIDB Pulau Pinang
Tingkat 7 Lot 9.01, Tingkat 9, Bangunan KWSP,
Grand Seasons Avenue No. 3009, Off Lebuh Tenggiri 2,
No. 72, Jalan Pahang Bandar Seberang Jaya,
53000 Kuala Lumpur. 13700 Seberang Jaya,
Tel : 03-4045 3800 Pulau Pinang.
Fax : 03-4045 3858 Tel : 04-390 2448
Fax : 04-390 7448
CIDB Kedah
Lot 7 & 8, Kompleks Perniagaan Asas Jaya CIDB Perak
Jalan Stadium Lot 5.02, Tingkat 5, Bangunan KWSP,
05000 Alor Setar Jalan Greentown,
Kedah 30450 Ipoh, Perak.
Tel : 04 733 1243 Tel : 05-2423 488
Fax : 04 733 1175 Fax : 05-2555 488

CIDB Johor CIDB Kelantan
Lot 2607, Batu 3, No U7.2, Tingkat 7, Menara Perbadanan
Jalan Tampoi, Jalan Tengku Petra, Semerak,
81200 Johor Bahru, Johor. 15000, Kota Bharu, Kelantan
Tel : 07-234 4808 Tel : 09-743 5311
Fax : 07-234 4807 Fax : 09-744 4311

CIDB Terengganu CIDB Tawau (Cawangan)
Tingkat 7, Menara Yayasan Islam Terengganu, Tingkat 1, Blok 35
Jalan Sultan Omar, Wisma Gek Poh, Batu 1
20300 Kuala Terengganu Jalan Dunlop/Kuhara
Terengganu Beg Berkunci No.7, 91009 Tawau, Sabah
Tel : 09-624 5311 Tel : 089-777 841/842
Fax : 09-623 8973 Fax : 089-777 840

CIDB Miri (Cawangan) CIDB Sabah
Tingkat 1, Wisma Rela Aman Blok A, Tingkat 4
Lot 1301, Blok 9, MCLD Bangunan KWSP
Miri Water Front 88100, Kota Kinabalu
98000 Miri, Sarawak Sabah.
Tel : 085-417 431 Tel : 088-235 060
Fax: 085-417 432 Fax : 088-242 481

CIDB Sarawak CIDB Melaka
Tingkat 1, Blok A, Kompleks CIDB, M1/3/40, Tingkat 2
Jalan Sultan Tengah, Bangunan Kota Cemerlang
93050 Kuching, Sarawak. Leboh Ayer Keroh
Tel : 06-232 8885 75450 Ayer Keroh, Melaka
Fax : 082-447 833 Tel : 082-445 833 / 446 833
Fax : 06-232 8950

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