Pendaftaran Kontraktor Tempatan Registration of Local Contractor

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1 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 Permohonan Kenaikan Gred/Tambah Kategori/ Tambah Pengkhususan 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 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

2 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 : Alamat surat-menyurat Correspondence address Poskod/Poscode:... Tel:... Fax : 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: (Tanda salah satu yang berkaitan) MS ISO 9002 Certification: (Mark whichever applicable) a) Ada b) Tiada c) Lain-lain:... Yes No Others (Sila Kemukakan satu salinan sijil) (Please submit a copy of certificate) 2

3 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 RM 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 (ii) SYARIKAT SENDIRIAN BERHAD/SYARIKAT BERHAD/KOPERASI DAN LAIN-LAIN PRIVATE LIMITED COMPANY/PUBLIC COMPANY/COOPERATIVE AND OTHERS Modal Saham/Share capital RM 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 Nilai Syarikat/Networth RM 1. Jumlah Aset tolak Jumlah Liabiliti berdasarkan lembaran imbangan terkini Total Assets less Total Liabilities based on latest balance sheet 3

4 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 Tahun pengalaman dalam bidang pembinaan # Years of experience in construction Industry # No. Pendaftaran Personel Binaan CIDB (jika ada) CIDB Construction Personnel Reg. No. (If any) Kelayakan Akademik- Kekompetenan Academic Qualification- Competency Certificate Warganegara Citizenship No. K/P. Baru* atau No. pasport jika Warganegara asing New I/C No.* or Passport no. if foreigner No. K/P. Lama Old I/C No. Jawatan Designation Nama Name Bil. No. 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 4

5 G. Senarai Projek Yang Telah Siap Dan Sedang Dilaksanakan List of Completed and Current Projects Nama Klien/Kontraktor Utama Name of Client/Main Contractor KU* Atau/or SK* Huraian Kerja Description of Works Nilai Projek Value of Project Tarikh Mula Date of Commencement Tarikh Siap Date of Completion Peratus Siap Percentage Completed Bil. No. Nyatakan KU (Kontrak Utama) atau SK (Subkontrak) State KU (Main Contract) or SK (Subcontract) * 5

6 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. Tandatangan: (Signature) Cop Syarikat/Firma (firm/company chop) Nama:.. (Name) Jawatan:. (Designation) No. K/P./No. Pasport:... (I/C No./ Pasport No.) Tarikh:.. (Date) 5 6

7 BORANG UPP 1 / 2 Bahagian Pembangunan Personel Binaan (Construction Manpower Development Division) Tingkat 7, Grand Seasons Avenue, No. 72, Jalan Pahang, Kuala Lumpur, P.O. Box , Kuala Lumpur. Tel : Fax : 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). 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 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)

8 CONSTRUCTION INDUSTRY DEVELOPMENT BOARD MALAYSIA HEAD OFFICE Level 7, Grand Seasons Avenue, No.72, Jalan Pahang Kuala Lumpur MALAYSIA Tel : Fax : 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, Kuala Lumpur Seberang Jaya, Tel : Pulau Pinang. Fax : Tel : Fax : CIDB Kedah Lot 7 & 8, Kompleks Perniagaan Asas Jaya CIDB Perak Jalan Stadium Lot 5.02, Tingkat 5, Bangunan KWSP, Alor Setar Jalan Greentown, Kedah Ipoh, Perak. Tel : Tel : Fax : Fax : CIDB Johor CIDB Kelantan Lot 2607, Batu 3, No U7.2, Tingkat 7, Menara Perbadanan Jalan Tampoi, Jalan Tengku Petra, Semerak, Johor Bahru, Johor , Kota Bharu, Kelantan Tel : Tel : Fax : Fax : CIDB Terengganu CIDB Tawau (Cawangan) Tingkat 7, Menara Yayasan Islam Terengganu, Tingkat 1, Blok 35 Jalan Sultan Omar, Wisma Gek Poh, Batu Kuala Terengganu Jalan Dunlop/Kuhara Terengganu Beg Berkunci No.7, Tawau, Sabah Tel : Tel : /842 Fax : Fax : 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 Miri, Sarawak Sabah. Tel : Tel : Fax: Fax : CIDB Sarawak CIDB Melaka Tingkat 1, Blok A, Kompleks CIDB, M1/3/40, Tingkat 2 Jalan Sultan Tengah, Bangunan Kota Cemerlang Kuching, Sarawak. Leboh Ayer Keroh Tel : Ayer Keroh, Melaka Fax : Tel : / Fax : CIDB Pahang A1, Ground 1st, 2nd & 3rd Floor, Jalan Seri Kuantan 2 Sri Kuantan Square Kuantan, Pahang Tel : /8953 Fax :

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