M A L A Y S I A

Lembaga Pembangunan Industri Pembinaan Malaysia

CONSTRUCTION INDUSTRY DEVELOPMENT BOARD MALAYSIA

Pendaftaran Kontraktor Tempatan

Registration of Local Contractor

R5

Application for Upgrading/Additional Category/Additional Specialization

Borang CIDB R1/95(Pin.2/01) / Form CIDB R1/95 (Rev.2/01)

Permohonan Kenaikan Gred/Tambah Kategori/ Tambah Pengkhususan

No. Siri / Serial No: ...........................................................................

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

A. Maklumat Pemohon Particulars of Applicant

No. Pendaftaran Perniagaan/Syarikat ......................................................................................................
Registration No. Of Business/Company Alamat berdaftar/ registered address (Seperti dalam borang D/borang 44/Annual Returns) (As stated in form D/form 44/Form 49) .......................................................................................... .......................................................................................... .......................................................................................... .......................................................................................... .......................................................................................... Poskod/Postcode: ............................................................ Tel : ....................................Fax : .................................... E-mail : ................................. Alamat surat-menyurat Correspondence address

........................................................................... ........................................................................... ........................................................................... ........................................................................... ........................................................................... ...........................................................................

Poskod/Poscode: ................................................................ Tel: ....................................... Fax : .................................... E-mail: ............................................................................... Webpage: ..........................................................................

B. Gred, Kategori dan Pengkhususan Semasa Current RegisterationGrade, Category and Specialization Gred Grade Kategori Category
B CE ME

Kod Pengkhususan Specialization Code

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) Gred Grade Kategori Category
B CE ME

Kod Pengkhususan Specialization Code

D. Persijilan MS ISO 9002:

a) Ada Yes b)

salah satu yang berkaitan) MS ISO 9002 Certification: (Mark whichever applicable)
Tiada No c) Lain-lain: Others .........................................................................................................

(Tanda

(Sila Kemukakan satu salinan sijil) (Please submit a copy of certificate)

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 Complete details in section

(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

Modal terkumpul/Net capital worth

1. Baki penyata akaun bank untuk tiga bulan yang terkini Balance of the latest three months bank account statements

RM

2. 3.

Amount of overdraft facilities

a) RM ...................................... } b) RM ......................................} c) RM ......................................} Amaun kemudahan overdraf

Jumlah (Total ) 3 =

4.

Fixed deposit(s) (including deposit(s) of sole proprietor or each partner) which is/are not charged to any bank or financial institution

Simpanan tetap (termasuk simpanan tetap pemilik tunggal atau setiap rakan kongsi) yang tidak dicagar pada mana-mana bank atau institusi kewangan Baki di akaun simpanan (termasuk akaun simpanan pemilik tunggal atau setiap rakan kongsi)

5.

Balance in savings account (including savings account of sole proprietor or each partner) Lain-lain (Saham ASB/ASN dll.) Others (ASB/ASN Shares etc.)

Jumlah/Total

(ii) SYARIKAT SENDIRIAN BERHAD/SYARIKAT BERHAD/KOPERASI DAN LAIN-LAIN PRIVATE LIMITED COMPANY/PUBLIC COMPANY/COOPERATIVE AND OTHERS
Modal Saham/Share capital 1. 2.
Jumlah modal berbayar/saham anggota dimiliki oleh badan/individu tempatan Total paid-up capital/shares of members owned by local bodies/individual(s)

RM

Jumlah modal berbayar dimiliki oleh badan/individu asing Total paid-up capital owned by foreign bodies/individual(s) Jumlah /Total Nilai Syarikat/Networth RM

1.

Jumlah Aset tolak Jumlah Liabiliti berdasarkan lembaran imbangan terkini Total Assets less Total Liabilities based on latest balance sheet

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

Bil. No. Jawatan Designation

Warganegara Citizenship

Nama Name No. K/P. Lama Old I/C No.

No. K/P. Baru* atau No. pasport jika Warganegara asing New I/C No.* or Passport no. if foreigner

Kelayakan AkademikIjazah@/Diploma/Sijil Kekompetenan Academic QualificationDegree@/Diploma/ Competency Certificate

No. Pendaftaran Personel Binaan CIDB (jika ada) CIDB Construction Personnel Reg. No. (If any)

Tahun pengalaman dalam bidang pembinaan # Years of experience in construction Industry #

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

G. Senarai Projek Yang Telah Siap Dan Sedang Dilaksanakan List of Completed and Current Projects

Bil. No. Nama Klien/Kontraktor Utama Name of Client/Main Contractor Nilai Projek Value of Project Tarikh Mula Date of Commencement Tarikh Siap Date of Completion

Huraian Kerja Description of Works

KU* Atau/or SK*

Peratus Siap Percentage Completed

Nyatakan KU (Kontrak Utama) atau SK (Subkontrak) State KU (Main Contract) or SK (Subcontract)

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)

5 6

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

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).
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).
Kategori / Tugas Contoh: Pekerja Mahir Binaan/ Penerap Bata, Tukang Konkrit Category /Task e.g.: Skilled Const. Worker/ Bricklayer, Concretor No. Pendaftaran Personel Binaan CIDB (jika ada) CIDB Construction Personnel Reg. No. (If any)

Bil. No.

Nama Name

No. K/P. (Baru & Lama) atau No. Pasport I/C No. (New & Old) or Passport No.

Alamat surat-menyurat Correspondence address

1.

2.

3.

4.

5.

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 Tingkat 7 Grand Seasons Avenue No. 72, Jalan Pahang 53000 Kuala Lumpur. Tel : 03-4045 3800 Fax : 03-4045 3858 CIDB Kedah Lot 7 & 8, Kompleks Perniagaan Asas Jaya Jalan Stadium 05000 Alor Setar Kedah Tel : 04 733 1243 Fax : 04 733 1175 CIDB Johor Lot 2607, Batu 3, Jalan Tampoi, 81200 Johor Bahru, Johor. Tel : 07-234 4808 Fax : 07-234 4807 CIDB Terengganu Tingkat 7, Menara Yayasan Islam Terengganu, Jalan Sultan Omar, 20300 Kuala Terengganu Terengganu Tel : 09-624 5311 Fax : 09-623 8973 CIDB Miri (Cawangan) Tingkat 1, Wisma Rela Aman Lot 1301, Blok 9, MCLD Miri Water Front 98000 Miri, Sarawak Tel : 085-417 431 Fax: 085-417 432 CIDB Sarawak Tingkat 1, Blok A, Kompleks CIDB, Jalan Sultan Tengah, 93050 Kuching, Sarawak. Tel : 06-232 8885 Fax : 082-447 833 CIDB Pulau Pinang Lot 9.01, Tingkat 9, Bangunan KWSP, No. 3009, Off Lebuh Tenggiri 2, Bandar Seberang Jaya, 13700 Seberang Jaya, Pulau Pinang. Tel : 04-390 2448 Fax : 04-390 7448 CIDB Perak Lot 5.02, Tingkat 5, Bangunan KWSP, Jalan Greentown, 30450 Ipoh, Perak. Tel : 05-2423 488 Fax : 05-2555 488 CIDB Kelantan No U7.2, Tingkat 7, Menara Perbadanan Jalan Tengku Petra, Semerak, 15000, Kota Bharu, Kelantan Tel : 09-743 5311 Fax : 09-744 4311 CIDB Tawau (Cawangan) Tingkat 1, Blok 35 Wisma Gek Poh, Batu 1 Jalan Dunlop/Kuhara Beg Berkunci No.7, 91009 Tawau, Sabah Tel : 089-777 841/842 Fax : 089-777 840 CIDB Sabah Blok A, Tingkat 4 Bangunan KWSP 88100, Kota Kinabalu Sabah. Tel : 088-235 060 Fax : 088-242 481 CIDB Melaka M1/3/40, Tingkat 2 Bangunan Kota Cemerlang Leboh Ayer Keroh 75450 Ayer Keroh, Melaka 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