Membership Registration

1 Start 2 Page 2 3 Page 3 4 Page 4 5 Page 5 6 Page 6 7 Complete

Important Notification

Please ensure that full payment has been made prior to submitting the application form.

For the breakdown of the fees, Click Here for Standard or Click Here for Small Block.

If you require an invoice before making payment, send an email to payment@gs1my.org, titled "Request Proforma Invoice for New Application".

Complete applications (full payment and necessary documentation) will be approved and emailed within 5 working days.

Company Name *

SST No.

Nature of Constitution *

Date of Formation *

Month

Day

Year

Name(s) of Sole-proprietor/Partners/Directors *

Present Issued Capital * RM

Type of Company

	Main Business	Secondary Business
Manufacturer	Manufacturer - Main Business	Manufacturer - Secondary Business
Wholesaler	Wholesaler - Main Business	Wholesaler - Secondary Business
Retailer	Retailer - Main Business	Retailer - Secondary Business
Others	Others - Main Business	Others - Secondary Business
Others (Please specify)	Others (Please specify)

Product(s) Manufactured/Traded *

(Please provide details and breakdown, eg. Biscuits, Shoes, Blouses)

Brand Names *

e.g. Coca-Cola, Nike, Abba, Onwards, etc. Please key in "Nil" if your company do not own any brand name.

Where can customers find your product? *

e.g. Tesco, 7-Eleven, Caring, Pusat Perubatan Universiti Malaya (PPUM), etc.

Are You the Brand Owner? *

Yes

Number of Employees *

Contact Personnel in Your Company

(*Email must be provided as the GS1 approval letter will be emailed to you. **Mandatory fields)
Title*	Salutation*	Name*	Position*	Department / Division*	Mobile Phone*	Personal Email
Title **CEO	Salutation *	Name *	Position *	Department / Division *	Mobile Phone *	Personal Email
Title **Person-in-Charge of Bar Coding	Salutation	Name	Position	Department / Division	Mobile Phone	*Personal Email
Title **Billing Contact/Accounts	Salutation	Name	Position	Department / Division	Mobile Phone	*Personal Email

Office Contact

(*Email must be provided as the GS1 approval letter will be email to you. If no group office email, please provide individual email.)

Address Line 1 *

Address Line 2

Address Line 3

Postcode *

State *

Telephone

Fax

Group Office Email *

Website / Facebook

I wish to apply for subscription under the following category:

Category *

I understand that Small Block Membership is only meant for Sole Proprietor or Partnership or for promotional, festive/seasonal-run, limited-run products and vouchers. All other incorporations are required to apply under the Standard Membership.

Issued Capital (Only for Standard Membership Sdn Bhd) :		Join Month :
Annual Fee :

Registration Fee	Annual Fee (Pro-Rate)	Advance (2-years)	VbG-PDSS & Barcode Number Generation (Optional)	*Deposit	Total Fees
Registration Fee 1050.00	Annual Fee (Pro-Rate)	Advance (2-years)	VbG-PDSS & Barcode Number Generation (Optional)	*Deposit	Total Fees

Important Notes: 1. Refer to the Standard Membership fee breakdown and Small Block Membership fee breakdown for Pro-Rate. 2. Standard Membership provides up to 1000 barcode numbers. 3. Small Block Membership is only meant for cottage/micro industry, promotional, festive-run, seasonal-run, limited run or vouchers use only. Up to 10 barcode numbers. Subject to review. 4. Security Deposit is equivalent to one and a half years annual fee. 5. Verified by GS1 - Product Databank Support & Services (VbG-PDSS) & Barcode Number Generation is optional. 6. VbG-PDSS for Standard Membership : RM 480.00, VbG-PDSS for Small Block Membership : RM 380.00.

Payment Method (All appropriate fees should made in favour of "GS1 MALAYSIA BERHAD", Maybank: 5-14208-626-707)
Select Method *

Transfer/Bank-In Slip *

Files must be less than 4 MB.
Allowed file types: gif jpg jpeg png pdf doc docx.

Cheque Number

GS1 Malaysia Berhad Bank Account Details
Account Name : GS1 Malaysia Berhad
Account No. : 5-14208-626-707 (GIRO or IBG only, Do not choose DUITNOW or Instant Transfer)
Bank Name : Maybank Berhad
Bank Address : No. 8-10, Jalan 53, Desa Jaya, Kepong, 52100 Kuala Lumpur.
Swift Code : MBBEMYKL

Payment via JomPAY
Biller Code:12013
Ref 1:Company Name

Also enclosed are certified copies of the following documents of the company:
Business Registration Certificate / Certificate of Incorporation / Latest Annual Return (LAR) / Referral Letter *

If you are a Sdn Bhd / or Bhd (Private Limited or Limited Company), it is COMPULSORY for you to submit your Form 9 or Section 14 document when you apply for a GS1 membership.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc docx xls xlsx zip.

Small Block Membership Acknowledgement Letter *

**Only Applicable for Small Block Membership Applicant. Acknowledgement Letter: [English Version] [BM Version]
Files must be less than 4 MB.
Allowed file types: gif jpg jpeg png pdf doc docx xls xlsx.

Acknowledgement *
Yes, I hereby certify the above are true and agree to the conditions

I certify that the above information is true to the best of my knowledge. I have read the Terms and Conditions governing GS1 Malaysia subscribers to the GS1 System and on behalf of my company agree to abide by the said Terms and Conditions. We hereby agree to provide GS1 Malaysia with full access to, and allow GS1 Malaysia the use of and to share all company and product information provided by our company as GS1 Malaysia deems necessary as a trusted source of product information for retailers, international buyers, trading partners and any other marketing and promotion activities.

Verified by GS1 - Product Databank Support & Services (VbG-PDSS) *
Yes, I understand the conditions

The Verified by GS1 - Product Databank Support & Services (VbG-PDSS) is an optional package of GS1 Malaysia Services, Platforms and Capacity Building Sessions. It will automatically renew every 3 years. If I do not wish to continue to renew the VbG-PDSS, I must inform GS1 Malaysia a minimum of 3 months before the next annual billing cycle, otherwise, the package will continue to be renewed and charges will be billed to my company.

UDI Use Acknowledgement *
Yes, I manufacture, sell or trade medical devices and will follow FDA UDI guidelines

No, I do not manufacture, sell or trade medical devices

I declare that I am a manufacturer, trader or distributor of medical devices and I will be using the GS1 Standards & Keys for the creation and assignment of Unique Device Identifiers (UDI) according to the US FDA Rule on Unique Device Identification System and that I will keep the information up to date.

Name *

Designation *
(CEO, MD, COO, GM, Director, Manager, Owner)

Date *
Month

Day

Year

This completed form together with the registration, annual and all appropriate fees made in favour of "GS1 MALAYSIA BERHAD", Maybank: 5-14208-626-707 and relevant documents are to be forwarded to:

GS1 Malaysia Berhad (1201396-K)
Wisma FMM, No.3, Persiaran Dagang, PJU 9, Bandar Sri Damansara, 52200 Kuala Lumpur.

Page 1 of 6

Main menu

Membership Registration