Company Registration Form

ReGisTRATiOn FORM

Use one form for each participant. Use one form for one programme. Please print or type details clearly. This form can be downloaded from SSM’s website at www.ssm.com.my. Kindly make copies if more forms are needed. Yes, please register me for the below programme:

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Fax your registration form and send your payment to:

COMTRAC

Level 12, Menara SSM @ Sentral, 7 Jalan Stesen Sentral 5, Kuala Lumpur Sentral, 50623 Kuala Lumpur Tel : +(603) 2299 4441 (Saffyah) / +(603) 2299 4440 (Farah) / +(603) 2299 4448 (Noor) / +(603) 2299 4435 (Zalina) Fax : +(603) 2299 4451 / +(603) 2299 4452 Email : comtrac@ssm.com.my

SSM is a registered training provider with Perbadanan Sumber Manusia Bhd under registration number 1846. Our programmes are SBL Claimable.

Save Paper, Save Trees, Save the Planet!

In support of the SSM Corporate Responsibility Agenda, all training materials will uploaded in CDrom in place of printed notes.

PARTiCiPAnT DeTAils: (Please Provide All Details)

Name __________________________________________________________ I/C No. _________________________________________ License Secretary No. _____________________________________________________________________________________________ Professional Body Name ___________________________________________ Membership No. _________________________________ Designation _____________________________________________________________________________________________________ Company _______________________________________________________________________________________________________ Address _______________________________________________________________________________________________________ _______________________________________________________________________________________________________________ Office Tel. No. ___________________________________________ Fax No. _________________________________________________ Mobile No....