Company Name Company Reg. No Address Postal code Town State Federal Territory of Kuala Lumpur Federal Territory of Labuan Federal Territory of Putrajaya Johor Kedah Kelantan Malacca Negeri Sembilan Pahang Perak Perlis Penang Sabah Sarawak Selangor Terengganu Full name ID type MyKad Passport Army, Police or others ID number ID copy (File format: pdf & jpg only) Email Landline Fax Mobile Business entity Sole Proprietor / Partnership Private Limited Type of business (platform) E-wallet app/E-money providers Website/E-commerce etc Self-service kiosks EDC terminal Parking operators Loyalty programme platforms Others Business registration form - SSM Customer Information and Privacy Protection By submitting this form, you hereby agree that PayHub may collect, obtain, store and process your personal data that you provide in this form for the purpose of receiving updates, news, promotional and marketing updates, promotional and marketing mails or materials from ATX. Submit
