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TYPE OF MEMBERSHIP
Type :
Provisional
 
Ordinary
PERSONAL DETAILS
Full Name (as in NRIC) :
NRIC No :
- -
Date of Birth :
NAMLIFA Membership No :
Sex :
Male
 
Female
 

Race :
Chinese
 
Indian
 
Malay
 
Others
 

Address 1 :
Address 2 :
Address 3 :
Postcode :
City, State :
Tel (O) :
Tel (H) :
Tel (HP) :
Fax :
Email Address :
Highest Qualification Attained :
SRP & Below
 
SPM
 
STPM / COLLEGE
 
Tertiary & Above
 

COMPANY DETAILS
Date Contracted as Agent :
Agent's Code :
Position :
Agent
 
ASM
 
USM
 
GSM
 
AM
 
CA
 

Work Time :
Full Time
 
Part Time
 

Company :
Agency :
TERMS & CONDITIONS
MODE OF PAYMENT
Select Payment
:
Amount
:
RM 0
* Please select method payment then fill up the payment form.
SUBMIT APPLICATION
I have read and agree to the Terms and Conditions