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- - Tandatangan / Signature
No. Kakitangan/Staff ID No.
Tertakluk kepada Terma-Terma dan Syarat-syarat / Terms and Conditions Apply.Potong disini/ Cut here
Keratan Pemohon Pendaftaran RapidKL / RapidKL Registration Applicant Slip
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Tandatangan / Signature
Untuk Kegunaan RapidKL / For RapidKL Use :
No Siri Kad / Card Serial No.
MyRapid
Tarikh Pungutan / Collection Date :
OKU / DisabledWarga Emas /
Senior CitizenPelajar / Student
Kampus / Campus :
Tarikh Pengaktifan / Activation Date :
Encik / Puan / Cik :
Mr / Ms :
Kerakyatan Negara
: Nationality: Warga Asing. Sila nyatakan. Foreign citizen. Please state.
Jumlah bayaran : Total Payment :
Emel / Email :
Permohonan Telah Disahkan Oleh :
Application Form Verified By :
RM:
No Telefon / Telephone No.
No Tel. Bimbit / H.phone No.
Warga Emas / Senior Citizen
Malaysia
No Siri Kad / Card
Serial No.
Jumlah bayaran :Total Payment :
RM :
OKU / Disabled Pelajar Sekolah Rendah / Menengah
No. Pasport / Passport No:
Tarikh Pengaktifan / Activation Date :
Tarikh Pungutan / Collection Date :
Pelajar Kolej / Universiti
OKU / Disabled
Warga Emas / Senior Citizen
Pelajar Sekolah Rendah / Menengah
Pelajar Universiti / Kolej
No. Pasport / Passport No.
No. KP / I/C No.
Tarikh Lahir / Date of Birth :
Encik / Puan / Cik :
Mr / Ms :
No. Kad Pelajar / Student Card
Sekolah / Kolej / Universiti :
School / College / University :
Borang Pendaftaran RAPIDKL / RAPIDKL Registration Form
Pembaharuan / Renewal
Butir Peribadi Saya / My Personal Details (Sila isi yang berkenaan / Please fill in where applicable)
Gantian / Replacement
Produk MyRapid Konsesi
No. Kad JKM / JKM Card No.
Baru / New
No. KP / I/C No.