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Nominee's Name :

Mr. Madam Miss Dr.
Designation :
Company Name:
ROC No. :
Address :
Postcode :
City :
State :
 (for Malaysia applicants only)
Country :
Tel :
 (country code + area + tel.no)
Fax :
(country code + area + fax.no)
e-mail :
Website :
Nature of Business :
No. Of Employee :
 person
Annual Sales Turn Over :
(IN USD)
Primary Product/
Services :
Achievement
(Award, ISO and etc.,) :

By submitting this application form, we understand and agree to :-

  • Pay a non-refundable processing fee of RM 500.00 (Malaysia Enterprise) or USD 200 (Foreign Enterprise) to the organiser for authentication purpose (cheque payable to e-Dynasty Holdings Sdn. Bhd.) .
  • Participate in the sponsorship program and the sponsor fee must be paid within 10 working days after receiving the official mail notification of winning.

Declaration :-
We declare that the facts stated in this nomination together with the accompanying information are true, correct and have satisfied the eligibility criteria.


Please send the following attachment to the organiser as soon as possible :-
1. Company Registration ( Form 49 ) - photocopy
2. Corporate Profile
3. Nominee's 5R photographs (formal) 4 pcs.
4. Any relavant document to support your nomination

Organiser Secretariat :-
74-3, 2nd. Floor, Jalan Radin Anum 1,
Taman Sri Petaling, 57000 Kuala Lumpur

This online nomination form only act as an indication of your intention to
participate in the selection process of the award.
Site visit and interview is required after document verification.
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