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JABATAN IMIGRESEN MALAYSIA

IMMIGRATION DEPARTMENT OF MALAYSIA


MAKLUMAT PEGAWAI DAGANG / EXPATRIATE INFORMATION (DP11)

No. Permohonan Jawatan : JKE/14201/JCAGN2901115


Tandakan (X) Dalam Petak Berkenaan / Mark (X) in Appropriate Box No. Permohonan DP11 : ESD/14201/631374/JCAGN2901917

A. MAKLUMAT SYARIKAT ATAU MAJIKAN / PARTICULARS OF COMPANY OF EMPLOYER Jenis Permohonan


Type of Application
1. No Pendaftaran Syarikat / Registration of Company No. :
8 0 7 8 9 8 - K Baru / New
2. Nama Syarikat / Majikan / Name of Company / Employer
Lanjutan / Extension
S M P A R T N E R S E N G I N E E R I N G C O N S T R U C T I O
N S D N . B H D . Agensi Pelulus / Approving Agensi
3. Alamat Syarikat / Majikan / Address of Company / Employer
JKPD JPA KHEDN
1 7 - 0 1 - 1 L O R O N G B A T U N I L A M 1 0 A B A N D A
R B U K I T T I N G G I MIDA SC BNM

MDEC
Poskod / Postcode : Bandar / City :
4 1 2 0 0
Jenis Pass / Type of Pass
4. No Telefon / Telephone No. :
0 3 3 3 2 4 5 8 7 9 Pas Penggajian / Employment
5. No Faks / Fax No. : Pass
0 3 3 3 2 4 5 8 7 9
6. E-mail : Pass Lawatan (Kerja Sementara) /
S O L L E H K A M A R U D D I N 2 7 @ G M A I L . Visit Pass (Temporary
Employment)
C O M
7. Pegawai Perhubungan Syarikat / Majikan / Contact Person from Company / Employer
Lain-lain / Others
T E N G K U M O H D S O L L E H B I N T E N G K U
K A M A R U D D I N VDR
Tempat / Place:
8. Jawatan / Position
___________________
D I R E C T O R
B. MAKLUMAT PEGAWAI DAGANG / PARTICULARS OF EXPATRIATE JP Visa

1. Nama Penuh / Full Name : Pass Khas / Special Pass


M A Y A N
2. Jantina / Gender : Cooling Off Period
X Lelaki / Male Perempuan / Female
Pinda Tempoh Sahlaku Pas /
3. Tarikh Lahir / Date of Birth : Amendment To Validity of The
1 3 / 0 3 / 1 9 7 3 Pass
4. Warganegara / Nationality :
C H I N E S E Pindah Pas /Transfer Endorsement
5. No Pasport / Passport No. :
E E 5 9 9 4 7 0 1 Lain-lain - Sila Nyatakan
Others - Please State
6. No Pasport Lama / Old Passport No. :
___________________
7. Tarikh Tamat Pasport /
Passport Expiry Date :
0 5 / 1 2 / 2 0 2 8
___________________
8. Tempat Dikeluarkan / Place
of Issue :
T I A N J I N
9. Tarikh Dikeluarkan / Date of
Issue :
10. Tarikh Masuk Malaysia / Date of Entry to Malaysia :
/ /
11. Alamat di Malaysia / Address in Malaysia

Poskod / Postcode : Bandar / City :

12. Jawatan / Position :


O P E R A T I O N E N G I N E E R
Cop Syarikat

13. Gaji Sebulan / Salary


permonth : RM
8 5 0 0 Company's Stamp

14. Tempoh Pas Dipohon / Duration of Pass Applied :


2 4 Bulan / Month

15. Tempoh Pas Diluluskan / Duration of Pass Approved :


1 2 Bulan / Month

16. No Cukai Pendapatan /


Income Tax No. :
C. AKUAN / DECLARATION
Saya memperakui bahawa maklumat kenyataan di atas adalah benar:
I hereby declare that the particulars / informations furnished above are true:
Tandatangan Majikan / Signature of Employer :
Nama Penuh / Full Name :
No. KPT / No. Pasport / I/C No. / Passport No. :
Jawatan / Position :
Tarikh / Date :
Bahagian Pas Penggajian MEETING NO.: ESD/JKE/2019/69, DATE: 07/03/2019 (Print Date:2021-12-15 11:17:52, Printed By: smpec1)

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