FORM IS GIVEN

FOR FREE
Lembaga Pembangunan
Industri Pembinaan Malaysia
CONSTRUCTION INDUSTRY DEVELOPMENT BOARD

http:/www.cidb.gov.my
PHOTO
Please paste one recent
i.c. size colour photograph
with glue. Do not use
stapler/cut the photo.
PHOTO MUST BE SHARP
& CLEAN
CONSTRUCTION PERSONNEL
REGISTRATION FORM
Correspondenceaddress: Permanentaddress if different:
EXTRA INFORMATIONS TO BE FILLED-UP BY FOREIGN WORKER
(Enclosecopyof passportwithvalidworkpermitcertifiedbyemployeras appearonworkpermit)
The Construction Personnel Registration Programme is based to Pekeliling
ProgramKad Hijau CIDB Bil.1/2000dan Bil.1/2001.
General instruction:
- This Formis to be readtogether withConstructionPersonnel Registration
Requirements &Procedures.
Primary
Others (pleasespecify)
General
Worker
Daily
Monthly
Years
Companynameandaddress:
Tel
no:
Fax
no:
I.c. no./
Birthcert.
/passport(if available)
Tel. no:
Permanentaddress if differentthanapplicant's address:
I hereby certify that all the informations given
and copy/ies of document/s enclosed with this
form are right and true.

Application/Registration will be automatically
deemed nullified for any false information and
action including lawsuit can be taken.
Years Years
Years
SRP/LCE
/PMR
SPM
/MCE
SKM**/
SPVM**
Polytechnic** Diploma**
Degree**
Construction
Worker
Skilled
Construction
Worker
Construction
Site
Supervisor
Construction
SiteManager
Administrative
Personnel
<29
<499
30-39
500-749
40-49
750-999
50-59
1000-1499
60-79
1500-1999
80-99
2000-2499
100-1119
2500-2999
120-139
3000-3999
140 or
4000 more
G. CERTIFICATION
(Certification can be made by officers as stated in
the registration procedure. For foreign worker,
certification can only be done by employer as
appeared in the work permit).
I hereby certiffy that informations given are true.
Sex: Male Female Marital status: Single Married Divorcee/Widow/Widower
Newi.c.
no:
Oldi.c.
no:
Nationality:
Full name:
Dateof
birth:
A. APPLICANT'S INFORMATION
(Enclose copy of certified i.c)
Signature&Date
Name
Passport
no:
Workpermit
expirydate:
CIDBRegistrationCardNo:
Borang Bermasalah Pengesyoran Kategori & Tred
Please where applicable. For renewal, informationfor A, F &G are necessary
to fill-up. Please enclose the certifieddocuments as instructed.
NEW REGISTRATION RENEWAL
Race: Religion:
Tel. no.:
Postcode
B. ACADEMIC/SKILL QUALIFICATION (Enclose copy of Technical Cerificate (marked **) if any)
C. INFORMATION OF OCCUPATION
D. EMPLOYER INFORMATION
Income in daily/monthly:
daily monthly
Amount of salary in RM:
Years Years
Field of skills & years of experience (please refer list of trades in the form)
1.
4.
2.
5.
3.
6.
Please jif self employed
Contractorregistrationno. withCIDB:
(Fill-up if applicant ages between 16 and 65 years old)
Name:
Sex:
Relationship:
-
Mobile
tel no:
Mobile
tel. no.:
Postcode
Postcode
Postcode
F. APPLICANT'S DECLARATION
Maklumat pewaris tidak diisi
Salinan sijil ....................................
tidak disertakan
Tiada pengakuan pemohon
Tiada pengesahan majikan
Lain-lain:

.................................................................
Bayaran kurang/tiada
Salinan k.p. tiada
Salinan pasport/permit tiada
Permit kerja syarikat lain
Permit kerja bukan binaan
Gambar tiada/tidak sesuai

E. BENEFICIARY INFORMATION
Assistant
Construction
Manager
Construction
Trainee
Pembaharuan
Tukar Kategori
Tukar Tred
KIV
Semakan Ke2:

GW
CW
SW
SS
AM
MG
LT
AD
Master**
Degree
Doctorof **
Phylosophy
(Withcapital letteras ini.c/passport)
O
F
F
I
C
E

U
S
E
Female Male
Tarikh terima: ................................... Bayaran: RM ................................ No. Resit: ....................................................................................
REGISTRATION FEE RENEWAL FEE
RM50
RM25
RM50 (5 YEARS)
RM25
RM50
(MAXIMUM
OF
RM50
RM70
RM100
(2 YEARS)
(3 YEARS)
(5 YEARS)
RM50
Payment can be made by
money order or bank draft
made payable to CIDB
Malaysia. Cash payment can
only be accepted for
submission at CIDB counter
Local worker
Signature&Date
Name
CERTIFICATION
Others (pleasespecify)
Foreignworker
workpermit
withone year or less
Local worker
ages above
Local worker
withone year or less
Foreignworker with
workpermit
more thanone year
Foreignworker with
workpermit
more thanone year
RM50
(AS IN
PERMIT)
WORK
2 YEARS)
UPP1 Pin.1/2014
Tingkat 10, Menara Dato' Onn,, Pusat Dagangan Dunia Putra,
No 45, Jalan Tun Ismail, 50480 Kuala Lumpur
Tel: 03-4047 7000 Fax No : 03-4047 7070
ages between
16and70 years
70 years
Foreignworker
workpermit