Nominees Signup (Company)

Malaysia Intellectual Property Elites
Registration Form

1Company Details

2Candidates / Entrepreneur and Contact Person

3Declaration

4MIPE Account Registration

Company Name*

Registration No*

Date of Incorporation*

Business Nature*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Tel. No*

Email*

Website*

Types of Industry Involvement*

Franchising

Branding

Advisory

Others

Types of Education Services (Others)*

Corporate's Brand Name

Primary Product / Services

No. of Employees

Achievement (Award, ISO & etc)

Nominee's / Contact Person*

Title First Last

IC/ Passport*

Date of Birth*

Nationality*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Contact No.*

Designation

Declaration (To be completed by the CEO / MD / President or equivalent)

I agree to the following terms.

I as the nominee listed on this application agrees to comply with all policies, rules and regulation adopted by the organiser from time to time. I also declare that the facts stated in this nomination together with the accompany information are true, correct and have satified the eligibility criteria.

Saya sebagai salon yang disenaraikan di atas permohonan ini bersetuju until mematuhi semua dasar, peraturan dan peraturan yang diterima pakai Oleh penganjur dari semasa ke semasa. Saya juga mengisytiharkan bahada fakta yang dinyatakan dalam pencalonan ini bersama-sama dengen malumat yang menyertai adalar benar, betal dan mempersiapkan kriteria kelayakan.

I hereby authorise the release and use, in connecting with Majlis Tindakan Pengguna Negara program of my name, company/ organisation name, likeness of my voice and photographs, including video or others forms of media, and I agree that no compensation shall be done to me or my company/ organisation for such usage if I or my company/ organisation selected as an award recipient.

Saya dengan ini membenarkan pembebasan dan penggunaan, dalam hubungan dengan program Majlis Tindakan Pengguna Negara bagi nama saya, nama syarikat /. Organisasi, gambaran suara dan gambar saya, termasuk video atau lain-lain bentuk media, dan saya bersetuju bahawa tiada pampasan yang perlu dilakukan untuk saya tau syarikat / organisasi saya untuk penggunaan tersebut jika saya tau syarikat / organisasi saya dipilih sebagai penerima anugerah.

MIPE Account Login Email

MIPE Account Login Password

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