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Identity Information

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Employer

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Personal Information
Name *  :
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Personal Identification *  :	-- Please Select -- New Identification card Number Old Identification card Number Passport No. Police No. Army No.  [?]
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Personal Information
Name *  :
Personal Identification *  :	-- Please Select -- New Identification card Number Old Identification card Number Passport No. Police No. Army No.  [?]
	- -

Select state of incident *  :	---- Please Select ---- Johor Darul Takzim Kedah Darul Aman Kelantan Darul Naim Melaka Bandaraya Bersejarah Negeri Sembilan Darul Khusus Pahang Darul Makmur Pulau Pinang Perak Darul Ridzuan Perlis Selangor Darul Ehsan Terengganu Darul Iman Sabah Sarawak W.Persekutuan (Kuala Lumpur) W.Persekutuan (Labuan) W.Persekutuan (Putrajaya) Singapura Lain-Lain
State branch / department *  :	-- Please Select -- [?]

Details of Employer Being Reported
Employer Name *  :
Employer Address *  :
Postcode :
City :
State :	---- Please Select ---- Johor Darul Takzim Kedah Darul Aman Kelantan Darul Naim Melaka Bandaraya Bersejarah Negeri Sembilan Darul Khusus Pahang Darul Makmur Pulau Pinang Perak Darul Ridzuan Perlis Selangor Darul Ehsan Terengganu Darul Iman Sabah Sarawak W.Persekutuan (Kuala Lumpur) W.Persekutuan (Labuan) W.Persekutuan (Putrajaya) Singapura Lain-Lain
Employer Number :
Telephone Number *  :	-
Details of Service with Employer Being Reported
Start Service Date *  :	[?]
Is EPF deduction made from your salary? *  :	-- Please Select -- Yes No
Are you still in service? *  :	-- Please Select -- Yes No
If you have resigned, please state date of resignation *  :	[?]

Earning / Salary Statement: Please enter earning/salary (RM) for year and month contribution is not paid

State type of withdrawal *  :

-- Please Select --

Please enter details below
Ticket Number *  :	[?]
Item *  :	[?]
Follow-up Information (Please state the follow-up information as requested by the EPF) *

Please state your detail enquiries or feedback here *  :

Employer's Information
Employer Name *  :
Business Registration Number *  :
Employer Representative Information
Name *  :
Personal Identification *  :	-- Please Select -- New Identification card Number Old Identification card Number Passport No. Police No. Army No.  [?]
	- -

Contact Information
(Please fill in at least one contact number)
House Telephone :	-
Office Telephone :	-
Mobile Telephone :	-
Email *  :

Contact Information
(Please fill in at least one contact number)
House Telephone :	-
Office Telephone :	-
Mobile Telephone :	-
Email *  :

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Contact Information
(Please fill in at least one contact number)
House Telephone :	-
Office Telephone :	-
Mobile Telephone :	-
Email *  :

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Feedback Option
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Feedback Type
(Please select one)
Complaint against EPF services	Complaint against EPF employees
Fraud report	Report Against Employer
Dispute	Appeal Request
EPF Service Request	Enquiry
Compliment

Feedback Type

(Please select one)

Complaint against EPF services

Complaint against EPF employees

Fraud report

Appeal Request

Dispute

Enquiry

EPF Service Request

Compliment

Feedback Type

(Please select one)

Complaint against EPF services

Complaint against EPF employees

Enquiry

EPF Service Request

Compliment