NIOSH | E-Daftar: Safety Passport Program

Course List *

Program Info

Program Info

I hereby understand and agreed with Terms of Entry Requirement. Please also note that from time to time, we may request for new Personal Data from you. By providing us with your Personal Data or continuing to communicate with NIOSH, we shall regard that you have consented to the processing of such data.

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Nationality *

Participant Full Name *

Participant MyKad/Passport No. *

Date of Birth *

Age *

Gender *

Male Female

Handphone No. *

Email *

Blood Type * Mandatory to fill

Any allergies? (e.g. food, medication, chemicals) *

Name Display on Card (Max 10 character) *

Immediate Family Member *

Relation *

Emergency Contact No. *

Industry *

Company Name *

Current Position *

Territory Area *
Please select OTHERS if your Territory Area is not in the list.

Site Name *
PS <site name>. Eg: PS DENGKIL

Site Name *

Vegetarian *

Yes No

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Sponsorship

Self-Sponsored

Company-Sponsored

Company Category*

Authority(LLM)
Concession
Contractor

Type of Concession*

Company/Organization Address *

Postcode *

State *

City *

Person In-Charge *

Person In-Charge Email *

Contact No. *

Do you require an e-invoice? *

Mailing Address *

Postcode *

State *

City *

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Payment

FPX / FPXB2B / Credit Card / Debit Card / QR & e-Wallet

SBL Khas

Government Local Order

NIOSH are pleased to inform you that we have partnered with Razer Merchant Services Sdn Bhd as our authorized payment gateway. When you proceed to the payment page, you will notice that Razer Merchant Services Sdn Bhd is displayed as the merchant.

Please confirm the mode of payment to be made.
Exchange of other payment modes is not allowed

The GL payment mode option is only eligible for listed companies.

After selecting a payment mode, switching to another payment mode is not allowed.

Please ensure that the HRD Corp Claimable Courses grant application has been approved by HRD Corp. Approval number must more than 14 characters. If approval number length is less than 14 characters, please insert zero in front of number, example: ( 123A_12_1234 --> 00123A_12_1234 )

NIOSH reserves the right not to process the application if the grant approval number entered is not approved or invalid.

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