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SHORT NAME: (Maximum 30 characters) *REGISTRATION NO. (ROC): AGENT CODE WEBSITE: If your company is a subsidiary, please state your parent company name according to the Registrar of Company (ROC). PARENTS COMPANY NAME: ROC NO: *MEMBER to which Association (Please state): (e.g. SFFLA / AFAM / PFFA / JOFFA) *GOVERNMENT LINK COMPANY (GLC): Yes No *COMPANY TYPE: Berhad Sdn. Bhd. Semi Government Enterprise MNC SME Public Listed *INDUSTRY: You can tick ( ) more than one where appl.

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