FOR OFFICE USE

Date Received: ___________________

Received by: ___________________
B1816 WTHLTR-MPJ
Reference No: ___________________

MYTV BROADCASTING SDN BHD

VENDOR/CONTRACTOR REGISTRATION FORM
1.0 COMPANY DETAIL

1.1 Company Address __________________________________________

__________________________________________

__________________________________________

1.2 Postcode __________________________________________

1.3 Town __________________________________________

1.4 State __________________________________________

1.5 Country __________________________________________

1.6 Contact Person / Position __________________________________________

1.7 Tel. No. __________________________________________

1.8 Fax No. __________________________________________

1.9 Email __________________________________________

1.10 Website __________________________________________

1.11 Branches (If any) __________________________________________

1.12 TYPE OF INCORPORATION

1.12.1 Sole Proprietor

1.12.2 Private Limited

1.12.3 Limited

1.13 Date of Incorporation: ______________________________

1.14 Place of Incorporation: ______________________________

1.15 Company Registration No.: ______________________________

1.16 Year 0f Registration: ______________________________

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1.17 NATURE OF BUSINESS (please tick one or all that are most appropriate)

1. Manufacturer

2. Sole Distributor

3. Authorized Agent

4. Trader

5. Contractor

6. Consultant

7. Others (Please specify)

2.0 FINANCIAL STATUS

2.1 CAPITAL STRUCTURE

2.1.1 Authorised Capital ________________________________

2.1.2 Paid-Up Capital ________________________________

2.1.3 Working Capital ________________________________

2.2 FINANCIAL FACILITIES

Type Institution Value (RM)

2.2.1 _______________ _____________________________ _____________

2.2.2 _______________ _____________________________ _____________

2.2.3 _______________ _____________________________ _____________

2.3 BANK ACCOUNT

Bank Branch Account No.

2.3.1 _______________ ______________________________ _____________

2.3.2 _______________ _______________________________ _____________

2.3.3 _______________ ______________________________ _____________

2.4 SALES / TURNOVER FOR THE LAST 3 YEARS

2.4.1 RM ____________

2.4.2 RM ____________

2.4.3 RM ____________

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2.5 PROFIT FOR THE LAST THREE (3) YEARS

2.5.1 RM ____________

2.5.2 RM ____________

2.5.3 RM ____________

3.0 CURRENT EMPLOYMENT STRUCTURE

3.1 BOARD OF DIRECTORS

% OF
NAME PASSPORT / I.C NO. NATIONALITY DESIGNATION
SHAREHOLDING

3.2 NUMBER OF PERMANENT STAFF

MANAGEMENT EXECUTIVE NON-EXECUTIVE TOTAL

Technical Non-Technical Technical Non-Technical

4.0 DETAILS OF PRINCIPAL / SUPPLIER / SUB-CONTRACTOR / DISTRIBUTORSHIP

4.1 PRINCIPAL / SUPPLIER / SUB-CONTRACTOR (Please list down and enclose the necessary documents)

Name & Address of Principal /

Type of Goods or Services Rendered
Supplier / Sub-Contractor

4.2 DISTRIBUTORSHIP (Please provide letter of appointment from principal company, supplier or manufacturer)

Product Principal

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5.0 FACTORY / SHOW-ROOM / WAREHOUSING FACILITIES

5.1. Address : __________________________________________________________________________

__________________________________________________________________________

5.2. Land Occupied Area _____________________(Sq. ft)

Own
Rented / Leased

6.0 EQUIPMENT AND PLANT LIST

Please state all equipment, plants and machineries whether owned or rental relevant to works/services to be
rendered. (Please provide an attachment list for all related equipment)

Item Description Ownership

7.0 PREVIOUS RELATED CONTRACT AND EXPERIENCE

Please state the contracts that have been secured in the past three years. Please enclose attachment for longer
list.

Year
Client Contract Details Contract Value
Awarded

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8.0 STATUTORY REGISTRATION AND CERTIFICATION (Please fill in the blank wherever is applicable)

8.1 PKK Registration No. __________________________________________

8.1.1 Validity Date __________________________________________

8.2 PKK Registered Nominee

8.2.1 First Nominee __________________________________________

Identity Card Number __________________________________________

8.2.2 Second Nominee __________________________________________

Identity Card Number __________________________________________

8.2.3 Third Nominee __________________________________________

Identity Card Number __________________________________________

8.3 CIDB Registration No. __________________________________________

8.3.1 Validity Date __________________________________________

8.4 Ministry of Finance Registration No. __________________________________________

8.4.1 Validity Date __________________________________________

8.5 SSM Registration No. __________________________________________

8.5.1 Validity Date __________________________________________

8.6 CERTIFICATION

Please attach copies of the following documents:

8.6.1 Company Profile

8.6.2 Form 9 Registration with Suruhanjaya Syarikat Malaysia
8.6.3 Form 24 Return of Allotment of Shares
8.6.4 Form 49 Return giving particulars in register of Directors, Managers and Secretaries and changes of
particulars
8.6.5 Certificate of registration with:
Pusat Khidmat Kontraktor (PKK)
Construction Industry Development Board (CIDB)
Ministry of Finance (MOF)
Jabatan Kerja Raya
Other Telecommunication companies
8.6.6 Type Approval from SIRIM for your companys product
8.6.7 ISO certificate
8.6.8 Member of any related Professional Body
8.6.9 Others (please specify)

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9.0 CATEGORY AND SPECIALIZATION THE COMPANY WISHES TO APPLY FOR

Please refer to the item 9.1 for detailed list of Category/Code/Specialization and state the most appropriate code/s
to be registered in table below.

No. Category Code/s to be registered

1 Consultancy Services

2 Contractor Broadcast & Engineering Services

3 Vendor Broadcast & Engineering Systems

4 Vendor Office Supply & Facility Systems

5 Vendor Information Technology Supply & Services

9.1 LIST OF CATEGORY/CODE/SPECIALIZATION

Category Code Specialization Description

1. Consultancy Services CS 01 1. Local 1. Project Management
CS 02 2. Foreign 2. Systems Integration
3. Broadcast systems
a. DMBH,
b. DRC
4. Transmission Systems
a. Transmitter and Antenna
b. Contribution and Distribution
Network
c. Satellite Communication
5. Customer Premise Equipment (CPE)
a. STB/Receiver Device
b. Antenna (Portable Indoor/Fixed
Rooftop)
6. Building and M&E
7. Customer Support and Services
8. RF Spectrum and Network Planning
9. Interior Decoration
10. Marketing & Branding
a. Above and below the line
b. B2B, B2C
11. Architecture
12. Quantity Surveyor

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 13. Accounting Services
14. Legal Services
15. Land and Geotechnical Surveyor
16. ISO Certification
17. Site acquisition
2. Contractor: CBES 01 1. Broadcast 1. Provide total solution inclusive of
Broadcast and Systems supply, installation, testing,
Engineering Services commissioning and maintenance of
Broadcast equipment.
CBES 02 2. Transmission 2. Provide total solution inclusive of
Systems supply, installation, testing,
commissioning and maintenance of
Broadcast transmission equipment.
CBES 03 3. Civil and 3. Provide total solution inclusive of road
Structural Works milling, road pavement, piling,
earthworks, drainage and slope
protection works, general civil repair
and maintenance.
CBES 04 4. Mechanical and 4. Provide total solution inclusive of
Electrical Works Internal Building, LAN & WAN, and
broadcast related cabling works.
CBES 05 5. Interior 5. Provide total solution inclusive of
Decoration design, supply, installation,
modification, refurbishment and
maintenance facilities.
CBES 06 6. Other 6. Contractual services such as
Engineering monitoring, operation or managed
Services services; or other related services that
are not mentioned in any of the above
categories.
3. Vendor: VBES 01 1. Broadcast 1. Supply, installation, testing and
Broadcast and Systems commissioning and maintenance of
Engineering Systems Broadcast equipment.
VBES 02 2. Transmission 2. Supply, installation, testing and
Systems commissioning and maintenance of
Broadcast transmission equipment.
VBES 03 3. CPE 3. Supply, installation, testing and

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 commissioning and maintenance of
Customer Premise equipment.
VBES 04 4. CC & CIC 4. Supply, installation, testing and
commissioning and maintenance of
Call Centers (CC) & Customer
Interaction Center (CIC) equipment.
VBES 05 5. IT & Networking 5. Supply, installation, testing and
commissioning and maintenance of
Information technology & network
equipment and peripherals.
VBES 06 6. Logistics 6. To provide freight services inclusive of
transportation and distribution,
customs classifications and custom
clearance, technical certifications,
packaging options, inventory
management, warehousing facility
with clear tracking and security.
VBES 07 7. Other 7. Services such as monitoring, operation
Engineering or managed services; or other related
Services services that are not mentioned in any
of the above categories.
4. Vendor: VOFS 01 1. Office Supplies 1. Supply of stationeries, pantry items
Office supply and etc
facilities Systems VOFS 02 2. Office Equipment 2. Supply and maintenance of office
equipment such as photocopier but
not limited to other office equipment
VOFS 03 3. Furniture & Fitting 3. Supply of office furniture and fitting
VOFS 04 4. Insurance 4. Insurance services
VOFS 05 5. Travel Agency 5. Travel agency (ticketing and hotel
booking)
VOFS 06 6. Security Services 6. Security Guard services
VOFS 07 7. Cleaning Services 7. Office/cabin cleaning services
VOFS 08 8. Renovation Works 8. General building works including
fixing partitions, built-in fitments,
flooring, roofing and refurbishment
works.

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 5. Vendor: VITS 01 1. Personal
Information Computer
Technology Supply (Laptop and
and Services Desktop)
VITS 02 2. Small and Large
Multi User
System Supply, install, testing, commissioning and
VITS 03 3. Software related maintenance of information
Products technology hardware and software
VITS 04 4. Other Computer products and services
Related
Service
VITS 05 5. Networking
Products and
Services
VITS 06 6. IT Manpower
Services

DECLARATION

We hereby declare that all information provided in this application is true and agree that MYTV Broadcasting Sdn Bhd
reserves the right to review this application at its sole discretion.

We confirm that we are not in any breach of any confidentiality in providing the information herein. We also have no
objection for MYTV Broadcasting Sdn Bhd to cross-reference to a third party, visit or audit our premises and facilities. We
will extend our assistance towards this exercise. We also fully understand that nothing in this proposal is intended to
constitute an agency, partnership or joint venture between the parties.

This registration shall terminate, without notice, (i) upon the institution by or against either party of insolvency,
receivership or bankruptcy proceedings or any other proceedings for the settlement of either partys debts, (ii) upon
either party making an assignment for the benefit of creditors, or (iii) upon either partys dissolution or ceasing to do
business. The requestor shall ensure that there are no pending or overtly threatened actions, claims, orders, decrees,
investigations, suits or proceedings by or before any governmental authority, arbitrator, court or administrative agency
which would have a Material Adverse Effect, which might result in any impairment of the right or ability of the requestor
to enter into or perform his obligations under this Agreement.

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Personal Data Protection Act 2010

(i) Personal Data of the Customer and/or third party

a) Subject to the terms and conditions of this Agreement, where the interested
consultant/vendor/contractor receives or process any personal data (as defined by Personal Data
Protection Act 2010) (PDPA) from any party on behalf of MYTV Broadcasting Sdn Bhd arising from the
performance of this Agreement, it shall ensure that it fully complies with the provisions of the PDPA and
only deals with the data to fulfill its obligations under the Agreement.
b) Without prejudice to any other interested consultant/vendor/contractor obligation to indemnify MYTV
Broadcasting Sdn Bhd under this Agreement, the interested consultant/vendor/contractor shall
indemnify MYTV Broadcasting Sdn Bhd for any breach of the PDPA which renders the latter for any costs,
claims or expenses.
c) In fulfillment of its obligations under the PDPA, the interested consultant/vendor/contractor shall have a
system in place to ensure:
i) full compliance with the PDPA; in particular the principles of the PDPA which deals with the security of
personal data;
ii) the reliability of all its employees who may be involved in receiving and processing the personal data
d) The Interested consultant/vendor/contractor shall take reasonable steps to ensure that all of its partners,
shareholders, directors, employees, contractors and agents comply with this Clause where they are
receiving and processing any personal data on behalf of MYTV Broadcasting Sdn Bhd during its performance
of this Agreement.
e) The Interested consultant/vendor/contractor shall allow MYTV Broadcasting Sdn Bhd reasonable access
to such information as is necessary to ensure that it is complying with the above provisions and the PDPA as
a whole.
f) Immediately following termination or expiry of this Agreement, MYTV Broadcasting Sdn Bhd partners are
obliged to comply and perform its obligations under this Agreement in respect of all personal data in its
possession or control.
(ii) Interested consultant/vendor/contractor Personal Data
a) The Interested consultant/vendor/contractor agrees and understands that by providing its personal data
and entering into this Agreement, the interested consultant/vendor/contractor acknowledges that the
interested consultant/vendor/contractor has given MYTV Broadcasting Sdn Bhd its consent to collect,
record, hold, store, use and disclose its personal information for purposes which are necessary or related to
this Agreement by MYTV Broadcasting Sdn Bhd according to the PDPA and MYTV Broadcasting Sdn Bhds
Privacy Statement.

SIGNATURE / CO. STAMP ______________________

NAME ______________________

I/C / PASSPORT NO ______________________

DESIGNATION ______________________

DATE ______________________

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 MYTV BROADCASTING SDN BHDS OFFICIAL USE

VENDOR/CONTRACTOR NAME : _________________________________________________________

Score Remarks

1.0 Company Details ______________________________________________

2.0 Financial Status ______________________________________________

3.0 Employment Structure ______________________________________________

4.0 Details of Principal/Supplier ______________________________________________

5.0 Factory / Show-Room /

Warehousing Facilities ______________________________________________

6.0 Equipment & Plant List ______________________________________________

7.0 Previous Contract & Experience ______________________________________________

8.0 Statutory and Certification ______________________________________________

Attachments (Forms)

Total ____ / 16

SCORING: Good - 2 9 to16 - Pass

Average - 1 6 to 8 - Sufficient
Not Suitable - 0 1 to 5 - Not Suitable

Processed by: _______________________________________ Date __________________

Verified by: _______________________________________ Date __________________

Head
Approved by: _______________________________________ Date __________________
Vice President

Comments:

Approved Supplier List no: ______________________

Updated in Approved Supplier List by: _______________________ Date ____________

Updated in ERP by: _______________________ Date ____________

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