Business Name / Company Name *

Company Registration Number *

Person-in-charge Full Name *

Person-in-charge Phone Number *

Person-in-charge Email Address *

Product Plan *

Type of Business *

Private Limited (Sdn Bhd) - Registered BEFORE 31 Jan 2017

Private Limited (Sdn Bhd) - Registered AFTER 31 Jan 2017

Sole Proprietor

Partnership

Penjaja (Hawkers)

Business Nature / Industry *

Tick box to declare fulfil the conditions *

Be owned by at least 60% Malaysian citizens

Be a registered SME in Malaysia with SSM

Be in operation for a minimum of six (6) months

Have an annual average sales turnover of at least RM50,000

I declare that my company fulfil the following conditions

I hereby declare that the information provided is true and accurate. I consent to TED Optimus Sdn. Bhd. collecting and processing my personal and business data for the purpose of my Madani Grant application and related services, in accordance with the Privacy Policy.

This concise statement covers accuracy, consent, and references your detailed privacy policy.