DAGANG NET TECHNOLOGIES SDN BHD (177974-T)

Tower 3, Avenue 5,
The Horizon, Bangsar South,
No. 8, Jalan Kerinchi,
59200 Kuala Lumpur, Malaysia

Tel: 603-2730 0200 Fax: 603-27713 2121
Careline: 1300 133 133
Website: www.dagangnet.com

         Form No: FM-355
         Rev No:2

 

 

 
R E G I S T R A T I O N    F O R M

(ONE FORM PER MAILBOX)
. Please complete the Registration and Dagang . Net services and Subscribers Agreement.

A.  COMPANY   INFORMATION  
Co.ROB/ROC No:*                   
Company Name: *

Contact Person For EDI System :*   

Contact Person Hand Phone No :*   

Contact Person E-Mail ID: *   



B. ADDRESSES  
Mailing address:*
(Select one only)

Company Address (ROC registered address)*
                  

                  

                  

Post Code : *           City :                State :    

Tel No: *                Fax No:*       

Billing Address (Same As Above )
                  

                  

                  

Post Code :                City :                State :    

Tel No:                    Fax No:      

Installation Address (If different from above)
                  

                  

                  

Post Code :                     City :                State :    

Tel No:                   Fax No:       



C. COMMUNITY SYSTEM :*      
FAMA 3P (3P FAMA) LEMBAGA PERLESENAN TENAGA ATOM (ATOMIC)
Banks and Financial Institutions (BANK) CIDB (CIDB)
Lembaga Koko Malaysia (COCOA) CRIM (CRIM)
JABATAN ALAM SEKITAR (DOE) JABATAN ALAM SEKITAR - OZONE UNIT (DOE-NAT)
DUTYNET (DUTYNET) ELECTRONIC MANIFEST SYSTEM (EMS)
ELECTRONIC PREFERENTIAL CERTIFICATE OF ORIGIN (EPCO) EPCO EVALUE PLAN (EPCO-EVALUE)
Electronic Excise System (EXCISE) Federal Agricultural Marketing Authority (FAMA)
LEMBAGA PENAPISAN FILEM (FINAS) GOVERNMENT (GOVT)
Ipoh(ICT) Community System (IPCS) Johor community system (JPCS)
JABATAN PERKHIDMATAN VETERINAR (JPV) KASTAM DIRAJA MALAYSIA (KASTAM)
Kedah community system (KDCS) Kelantan (KLCS)
Labuan community system (LBCS) Lumut community system (LMCS)
JABATAN PERKHIDMATAN KUARANTIN & PEMERIKSAAN MALAYSIA (MAQIS) (MAQIS) Melaka community system (MCS)
MIN. OF INT. TRADE AND INDUSTRIES (MITI) Malaysian Timber (MTIB)
Lembaga Perindustrian Nanas (NANAS) Negeri Sembilan community system (NSCS)
BAHAGIAN INDUSTRI PADI DAN BERAS (PADI&BERAS) POLIS DIRAJA MALAYSIA (PDRM)
JABATAN PERLINDUNGAN HIDUPAN LIAR (PERHILITAN) Jabatan Perikanan Malaysia (PERIKANAN)
Jabatan Pertanian (Pesticide Board) (PESTICIDE) FARMASI (PHARMACY)
Kuantan community system (PHCS) Port Klang community system(FA) (PKCS)
Port Klang community system(SA) (PKSA) Perlis community system (PLCS)
PORT (PORT) Penang community system (PPCS)
Persatuan Kayu Sarawak (PUSAKA) KLIA Community system (SACS)
Sabah community system (SBCS) SIRIM (SIRIM)
SURUHANJAYA TENAGA (SJT) SMK-EAI (SMK-EAI)
SIRIM CERTIFICATE OF APPROVAL (SRCOA) STRATEGIC TRADE ACT (STA)
Sarawak community system (SWKCS) TIME GROUP (TIMEGRP)
LEMBAGA TEMBAKAU NEGARA (TOBACCO) Kemaman Supply Base community system (TRCS)
JABATAN PERKHIDMATAN KUARANTIN TUMBUHAN (TUMBUHAN) FOREST DEPARTMENT SARAWAK (YPH)
JABATAN PERTANIAN SARAWAK (YPK) STATE VETERINARY AUTHORITY (SVA) SARAWAK (YPV)

Customs Station:*

D. CONNECTIVITY      
Dail-up
         Lease-line
 
Internet service provider:
Jaring
         TIME dotCom
TM Net
         Maxis
             Others
             (Please specify : )  


E. PURCHASING ITEM(S)
TRADITIONAL SMK
Front-end Software   Shipping Agent  
Free Commercial Zone   Bonded Warehouse  
Forwarding Agent   Freight Forwarders  
Dangerous Goods   EFT/Consignee  
Admin Password  
WEB-BASED APPLICATION
BPS   UBSCM  
User Activation   EMS011  
EFT   eDeclare  
ePermit   WebCareline  
eManifest   eInsurance  
MyPorts   EMS010  
EMS012   EMS013  
Billing   FSPG  


Vendor Type:*  
Company Type:*  


F. REGISTRATION DOCUMENT COMPLETED BY  
Name:
Designation

 

 
Signature Co-Stamp
Date    
       


IMPORTANT : THE FOLLOWING MUST BE ENCLOSED WITH THE REGISTRATION FORM (WHERE APPLICABLE)

A. REGISTRATION FOR MALAYSIAN (INDIVIDUAL/COMPANY)
    1. A photocopy of your identity card (both sides)
    2. A photocopy of Business Registration (where applicable)
    3. Form D and A or Form D and B (Proprietor or partnership)
    4. Form 49 and Form 9 or Form 49 and Form 13 (Company)
    5. Forwarding/Shipping Agent License

B. REGISTRATION FOR NON-MALAYSIAN
    1. A photocopy of your passport
    2. A copy of Form 79 or Form 80 or Form 80A or Form 83 or Form 83A

C. PLEASE SIGN AND RETURN THE REGISTRATION FORM TOGETHER WITH PAYMENT FOR REGISTRATION FEE, STAMPING FEE,
    ANNUAL RENEWABLE LICENSE CHARGE (ARLC) AND APPLICATION SOFTWARE CHARGE(IF APPLICABLE).



D A G A N G . N E T    S E R V I C E S    A N D   S U B S C R I B E R S    A G R E E M E N T

I/We
 (name of Company)
having a principal office at  
 

hereby agree to be bound by the terms and conditions as provided in this Agreement as the same may,
by notification, be ammended or supplemented from time to time.

.  Date :
    Name of Authorised Signatory :
.  Designation :
.  NRIC NO.:
 
.  Signature :  
   
.  Witness' Signature :
.  Witness' NRIC No.:
   
   
   
.  Company Stamp:
 

O F F I C E  U S E  O N L Y
RECEIVED (please check items received)
* Tick where applicable

  Registration Form (filled and completed)     PAYMENT  RECEIVED   AMOUNT (RM)
  FA/SA copy of license     Registration Fee  
  Form 9 or 13     Stamping Fee  
  Form 24/49     Application Software  
  Others (please specify)     ARLC  
    AMC  
   
  Total Received  

  EDI Mailbox No  
  Account No  
  Service Activation Date  
  Billing Activation Date  
  Installation Date  
  Verified and Confirmed by:  
  Signature:  
  Date:  


To Read Rules and Regulations For Electronic Data Interchange..........