Agent Registration Form
Kindly fill in the following Registration Form with your relevant details.
All information provided herein will be kept strictly confidential.
Agent/Negotiator
Name of Agent/Negotiator *
NRIC/Passport No. *
CREN/License No. Email *
Primary Contact No. *
  * indicates a required field
Agency
Name of Agency
 
Address
Street Address
City/Town
 
Zip/Postal Code
 
State/Province
Country
Office Phone No.
Office Fax No.
 
Other Information
Please feel free to enter any comments or questions you might have:
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In the event you have provided us with your personal data in the course
of your dealing with us, please note that the processing of your personal
data is subject to Wing Tai Malaysia Berhad's Privacy Policy.

Please click here for our Privacy Policy.