Application Form/Borang Permohonan
Application For Authentic Sabah Certification/Permohonan Bagi Pensijilan Authentic Sabah
Section A/Bahagian A
Company Information/Maklumat Syarikat
Company Name/Nama Syarikat:
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Company Registration No./No.Pendaftaran Syarikat:
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Company Address/Alamat Syarikat:
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District/Daerah
State/Negeri
Postcode/Poskod
Location Map of Premises/Factory
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Coloured Photos of Premises/Factory (Outside & Inside)/Foto Berwarna Premis Perniagaan (Pandangan Luar & Dalam)
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Company Phone Number/No. Tel Syarikat:
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Format: (000) 000-0000.
Company Fax Number./No.Faks Syarikat:
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Format: (000) 000-0000.
Company Email/Emel Syarikat:
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Type of Industry/Jenis Industri:
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Micro Enterprise/Enterprise Mikro
Medium Enterprise/Enterprise Sederhana
Small Enterprise/Enterprise Kecil
Multinational/Industri Besar
Type of Ownership/Status Milikan:
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Individual/Sole Propietorship/Perseorangan
Partnership/Perkongsian
Private Limited Company/Syarikat Sendirian Berhad
Public Limited Company/Syarikat Berhad
Other/Lain-lain:
Annual Sales Revenue RM/Hasil Jualan Setahun RM:
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Annual Sales Value < RM300,000/Nilai Jualan Tahunan < RM300,000
Annual Sales Value Between RM300,000 & < RM15 Million/Nilai Jualan Tahunan Antara RM300,000 & < RM15 Million
Annual Sales Value Between RM15 Million & Rm50 Million/Nilai Jualan Tahunan Antara RM15 Juta & RM50 Juta
Annual Sales Value > Rm50 Million/Nilai Jualan Tahunan > Rm50 Juta
Total No. of Employee/Jumlah Pekerja:
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No.of Local Employee/Bil. Pekerja Tempatan:
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No.of Foreign Employee/Bil. Pekerja Asing:
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Section B/Bahagian B
Applicant Information/Maklumat Pemohon
Full Name/Nama Penuh:
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First Name
Last Name
Designation/Jawatan:
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Phone NumberNo.Telefon:
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Email/Emel
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A Copy of Applicant Identity Card (IC) /Salinan Kad Pengenalan (K/P) Pemohon
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Section C/Bahagian C
Product Information/Maklumat Produk
Product Name/Nama Produk:
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Produk Category/Kategori Product:
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Please Select
Food & Beverages
Health
Personal Care
Beauty
Accessories
Arts & Crafts
Textiles/Men & Women Fashion
Furniture
Electronics
Home Appliances
Mom & Babies
Kids & Toys
Annual Production Capacity/Kapasiti Pengeluaran Setahun:
Product Market/Pasaran Produk:
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Rows
Local/Tempatan (%)
District/Daerah (%)
State/Negeri (%)
National/Kebangsaan (%)
TOTAL (%)
Domestic/Domestik
Export/Eksport
Ingredients Used of Product/Bahan Ramuan Produk:
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Rows
Name of Ingredients/Nama Bahan Ramuan
Domestic/Dalam Negara (Specify the State/Nyatakan Negeri)
Percentage/Peratus (100%)
Import/Import(Specify the Country/Nyatakan Negara)
Percentage/Peratus (100%)
Form of Ingredients/Bentuk Bahan Ramuan
Quantity of Each Ingredients/Kuantiti Setiap ramuan. (kg/g/mg)
Percentage/Peratus (100%)
Ingredients/Banan Ramuan 1
Ingredients/Bahan Ramuan 2
Ingredients/Bahan Ramuan 3
Ingredients/Bahan Ramuan 4
Ingredients/Bahan Ramuan 5
IngredientsBahan Ramuan 6
Ingredients/Bahan Ramuan 7
Ingredients/Bahan Ramuan 8
Ingredients/Bahan Ramuan 9
IngredientsBahan Ramuan 10
Production Flow of Product/Carta Aliran Produk:
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Rows
Domestic/Dalam Negara (Specify the State/Nyatakan Negeri)
Percentage/Peratus (100%)
Import/Import(Specify the Country/Nyatakan Negara)
Percentage/Peratus (100%)
Raw Material/Bahan Mentah
Idea & Design/Idea & Reka Bentuk
Product & Service/Produk & Perkhidmatan
Manufacturing/Pembuatan
Packaging/Pembungkusan
Distribution/Pengedaran
Marketing & Retailing/Pemasaran & Peruncitan
Coloured Product Image/Gambar Produk Berwarna:
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Type of Packaging Material Used with Description/Jenis Bahan Pembungkusan dan Keterangan:
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Section D/Bahagian D
Company Assessment/Penilaian Syarikat
Annual Sales Ratio of Product/Nisbah Jualan Tahunan Produk:
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Rows
Local/Tempatan
District/Daerah
State/Negeri
National/Kebangsaan
Luar Negara/International
TOTAL (%/RM)
Percentage/Peratus (100%)
Revenue/Pendapatan (RM)
Marketing Method/Kaedah Pemasaran:
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Rows
Physical/Fizikal
Online/Dalam Talian
Percentage/Peratus (100%)
Revenue/Pendapatan (100%)
E-Commerce Platform. For Example Shopee, Facebook, Website. If Any/Platform E-commerce. Contohnya Shopee, Facebook, Website. Jika Ada :
Automation Ratio of Products /Nisah Penggunaan Mesin & Peralatan Produk:
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Rows
Machinery/Mesin (%)
Manual/Manual (%)
Machinery & Manual/Mesin & Manual (%)
Outsources/OEM (%)
Digital/Digital
TOTAL(%)
Raw Materials/Bahan Mentah
Idea & Design/Idea & Reka Bentuk
Product & Services/Produk & Perkhidmatan
Manufacturing/Pembuatan
Packaging/Pembungkusan
TOTAL (%)
Others Applicable Certificate/Lain-lain dokumen Pensijilan (MeSTI, HALAL, GMP, HACCP, ISO):
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Copy of Relevent Licence by Local Authority with valid period. For Example, KKM, DOSH, DBKK, KPDNHEP,/Salinan Lesen yang dikeluarkan oleh Pihak Berkuasa Tempatan, masih sah. Contoh, KKM, DOSH, DBKK, KPDNHEP:
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Section E/Bahagian E
Personal Data Protection Act 2010
I confirm that/Saya mengaku bahawa:
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AUTHENTIC SABAH CERTIFICATION AGREEMENT
Click "TERM & CONDITIONS" above and it will link to the Authentic Sabah Certification Agreement/Klik "TERM & CONDITIONS" di atas dan ia akan link kepada Perjanjian Pensijilan Authentic Sabah.
Please read the following. Download the Authentic Sabah Certification Agreement and prepare TWO (2) sets of Authentic Sabah Certification./Sila baca Perjanjian tersebut. Muat turun Perjanjian Pensijilan Authentic Sabah dan sediakan DUA (2) set salinan Perjanjian Pensijilan Authentic Sabah.
Attach TWO (2) pcs of stamp duty (RM10.00) each to the space provided./Lekatkan DUA (2) keping setem duti (RM10.00) setiap satu pada ruang yang telah disediakan.
The Authentic Sabah Certification Agreeement need to be sign by the applicant and witness and date on the documents./Perjanjian Pensijilan Authentic Sabah hendaklah ditandatangani oleh pemohon dan saksi dan ditarikhkan pada dokumen tersebut.
The complete documents need to be return to DIDR./Dokumen yang lengkap hendaklah dikembalikan kepada pihak DIDR.
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