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MAHFAA FORM B ( AFFILIATE )
1. Applicant's Personal Information
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* Indicates required question
Applicant's Full Name
*
As Written On IC
Your answer
MyKad / Passport Number
*
No Dashes Or Spaces
Your answer
Email
*
Your answer
Phone Number
*
Your answer
Ethnicity
*
Malay
Chinese
Indian
Other:
Religion
*
Islam
Christian
Hindu
Buddha
Other:
Marital Status
*
Single
Married
Widowed
Divorced
Highest Level of Education
*
Primary (UPSR)
Secondary (SRP/PMR/PT3)
Secondary (SPM)
Undergraduate (Degree and below)
Postgraduate (Master's and above)
None
Other:
Current Occupation
*
Your answer
House Address
*
Your answer
Street
*
Your answer
Postcode
*
Your answer
State
*
Choose
Selangor
Perak
Johor
Negeri Sembilan
Melaka
Pahang
Terengganu
Kelantan
Kedah
Perlis
Pulau Pinang
Sabah
Sarawak
Wilayah Persekutuan Putrajaya
Wilayah Persekutuan Kuala Lumpur
Wilayah Persekutuan Labuan
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