Change Company Name Form

Company Name*

New SSM No.*

Old SSM No.

MSIB No.

Services Option*

Propose Company Name*

Minimum 3 names

Other Details

#1 Supporting Doc.

Max. file size: 256 MB.

#2 Supporting Doc.

Max. file size: 256 MB.

Documents to Sign Send By ?*

Self sign at MSIB office

Email to representative

Ready Documents Collect By ?*

Self pickup at MSIB office

Email to representative

Courier to client’s place

Shipping Address*

Street Address Address Line 2 City State Postcode Country

Representative As Director / Shareholder ?*

Yes

No

Role / Relationship

Brief Details About Role / Relationship Above

Representative Name*

Representative NRIC / Passport No.

House Address*

Street Address Address Line 2 City State Postcode Country

Phone No.*

Email Address*

NRIC / Passport Copy*

Max. file size: 256 MB.

Representative declaration & signature*

I hereby confirm the info given in this form is true and gathered legally by me with the consent from all the person involved

I hereby agree that all payment paid for this application is non-refundable and non-transferable (no contra allowed) to any other services

Sign Here*

Sales / PIC Person Name*

Sales / PIC Person Email*

Total to Pay

Payment By*