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Agent Registration
Applications are reviewed by Rozfa admin
Company Details
Company Name *
Email (login) *
Address *
SSM No. *
SSM Certificate * (PDF / image)
TIN No.
SST Reg No.
Person In Charge (PIC)
PIC Name *
PIC Tel No. *
PIC Email
Account
Password (min 6) *
I agree to the
Terms & Conditions
*
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