Name

New IC Number

Mobile Number

Email

How do you know KOJADI Referrals Existing Members KOJADI Online Platform Roadshow SAME / SME Association Trade Association Newspapers Sales Activity Consultant Others

If others, please specify

Business Registered Name

Business Registration No.

Entity Business licensed by local authority Sole-Proprietor Partnership Private Limited Company Others

If others, please specify

Business Premises Address

Postal Code

City

State

Business Premises Size

Business Contact Number

Business Email

Years in Operation

Turnover / Revenue p.a. (RM)

Example: 10000.00

Number of Staff

Loan Amount To Apply (RM)

Example: 10000.00

Security question : 3 + 1 is

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Disclaimer on Online Data Submission

Please note that the submission of your personal data is entirely voluntary. We will endeavour to take all reasonable steps to protect the personal information you may transmit to us and strive to ensure the security, integrity and privacy of personal information submitted by you. However, no data transmission over the Internet can be guaranteed to be totally secure. KOJADI assumes no liability for any damage or loss resulting directly or indirectly from the submission of your personal data via the internet.

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