[04] Nama
>>
(Seperti tercatat dalam Kad Pengenalan)
[05] Tarikh Lahir
>>
Hari 11 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Bulan
01 1 2 3 4 5 6 7 8 9 10 11 12 Tahun 1987
1940
1941 1942
1943 1944
1945 1946
1947 1948
1949 1950
1951 1952
1953 1954
1955 1956
1957 1958
1959 1960
1961 1962
1963 1964
1965 1966
1967 1968
1969 1970
1971 1972
1973 1974
1975 1976
1977 1978
1979 1980
1981 1982
1983 1984
1985 1986
1987 1988
1989 1990
[06] Negeri Lahir
>>
JOHOR DARUL TAKZIM JOHOR DARUL TAKZIM KEDAH DARUL
AMAN KELANTAN DARUL NAIM MELAKA NEGERI SEMBILAN DARUL
KHUSUS PAHANG DARUL
MAKMUR PERAK DARUL
RIDZUAN PERLIS INDRA
KAYANGAN PULAU PINANG SABAH SARAWAK SELANGOR DARUL EHSAN TERENGGANU
DARUL IMAN WILAYAH PERSEKUTUAN KUALA
LUMPUR WILAYAH PERSEKUTUAN
LABUAN WILAYAH PERSEKUTUAN
PUTRAJAYA BRUNEI INDONESIA SINGAPURA THAILAND LAIN-LAIN
NEGARA
[07] Keturunan
>>
MELAYU MELAYU BUGIS BOYAN BANJAR JAWA JAWI
PEKAN MINANGKABAU BUMIPUTERA SABAH BAJAU DUSUN KADAZAN MURUT SINO-NATIVE SULUK BINADAN BISAYA BONGOL BRUNEI BRUNEI DUMPAS IRRANUN IDAHAN KWIJAU KEDAYAN LINGKABAU LUNDAYEH LASAU MELANAU MANGKAAK MATAGANG MINOKOK MELAYU
SABAH MOMOGUN PAITAN RAMANAU RUNGUS SUNGAI SONSONGAN SINULAHAN TAMBANUO TAGAL TINAGAS COCOS KIMARAGANG BOLONGAN BUTON BUMIPUTERA
SARAWAK MELAYU SARAWAK MELANAU KEDAYAN IBAN ATAU SEA
DAYAK BIDAYUH ATAU LAND
DAYAK KAYAN KENYAH MURUT ATAU LUN
BAWANG KELABIT PENAN ATAU PUNAN BISAYA BERAWAN BELOT BUKIT BALAU BATANG
AI BATU ELAH BUKITAN BINTULU BADANG DUSUN JAGOI KIPUT KAJANG KAJAMAN KANOWIT LIRONG LEMANAK LAHANAN LUSUM ATAU
LUGUM MATU MALOH MELIKIN MELAING MURIK MENONDO NYAMOK SEBOB SEDUAN SEKAPAN SEGALANG SIAN SIPENG SARIBAS SEBUYAU SKRANG SABAH SELAKAN SELAKAU TAGAL TABUN TUTONG TANJONG TATAU TAUP UKIT UNKOP ULU AI ORANG ASLI
(SEMENANJUNG) JAKUN NEGRITO SAKAI SEMAI SEMALAI TEMIAR SENOI PENAN INDIA MALAYALI PUNJABI SIKH TAMIL TELEGU MALABARI INDIA
MUSLIM BANGLADESHI PAKISTANI SRI
LANKA TAMIL SRI LANGKA MELAYU SRI LANGKA SINHALESE INDONESIAN TIDUNG CINA CANTONESE FOOCHOW HAINANESE HENGHUA HOKCHIA HOKCHIU HOKKIEN KHEK
(HAKKA) KWONGSAI TEOCHEW LAIN-LAIN
ASIA ARAB BURMESE EURASIAN FIJIAN FILIPINOS GURKHA JAPANESE KHMER KOREAN MALTESE PORTUGESE SIAMESE VIETNAMESE IRANIAN AFGHAN CAUCASIAN KYRGYZ UBIAN EUROPEAN BRITISH ALGERIA ANTIGUA-BARBUDA AUSTRALIA ANGOLA ARGENTINA ALBANIA AUSTRIA MIDDLE
AFRICA SOUTH AFRICA BAHRAIN BAHAMAS BARBADOS BELIZE BOTSWANA BENIN BHUTAN BOLIVIA BRAZIL BURUNDI BULGARIA BELGIUM BELARUS BOSNIA-HERZEGOVINA CAMEROON CHAD CANADA CYPRUS CAPE
VERDE CROTIA CHILE COLOMBIA COMOROS COSTARICA CUBA DJBOUTI DOMINICA DAHOMEY DENMARK EQUADOR EL
SALVADOR EQUATORIAL
GUINEA ETOPIA FRANCE FINLAND GABON GAMBIA GUINEA GUINEA-BISSAU GHANA GRENADA GUYANA GUATEMALA GREECE GERMANY HAITI HONDURAS HUNGARY HONG
KONG IRAQ IVORY COAST ISRAEL IRELAND ITALY ICELAND JORDAN JAMAICA KUWAIT KENYA KIRIBATI KOREA(UTARA) KEMBOJA LEBANON LIBYA LESOTHO LAOS LIBERIA LUXEMBOURG MALI MALDIVES MAURITANIA MOROCCO MALAWI MADAGASCAR MAURITIUS MEXICO MOZAMBIQUE MONGOLIA MESIR MYANMAR NAMIBIA NAURU NEW
ZEALAND NIGERIA NEPAL NICARAGUA NETHERLAND NORWAY OMAN PAPUA NEW GUINEA PALESTIN PANAMA PARAGUAY PERU POLAND QATAR ROMANIA RWANDA REPUBLIK
CZECH REPUBLIK SLOVAKIA SENEGAL SIERRA
LEONE SOMALIA SUDAN SYRIA ST.LUCIA ST.VINCENT SYCHELLES SOLOMON
ISLAND SRI LANKA SWAZILAND SAMOA SAO TOME &
PRINCIPE SURINAM SAMOA BARAT SWEDEN SPAIN SWITZERLAND TUNISIA TURKEY TANZANIA TONGA TRINIDAD &
TOBACO TUVALI TOGO TAIWAN UGANDA UNITED ARAB
EMIRATES UPPER VOLTA URUGUAY RUSSIA UKRAINE UNITED
STATES VANUATU VENEZUELA YEMEN YUGOSLAVIA MACEDONIA ZAIRE ZAIRE ZAMBIA ZIMBABWE LAIN-LAIN MAKLUMAT
TIADA
[08] Kecacatan
>>
TIDAK CACAT TIDAK CACAT BISU BUTA CACAT KAKI CACAT TANGAN GAGAP LUMPUH PEKAK PEKAK (BOLEH MENDENGAR DENGAN BANTUAN ALAT
PENDENGARAN) RABUN (TIDAK TERMASUK BERKACA
MATA AKIBAT RABUN JAUH/DEKAT) RABUN
WARNA KUDUNG KAKI KUDUNG TANGAN LAIN-LAIN
KECACATAN
[09] Jantina
>>
LELAKI LELAKI PEREMPUAN
[10] Agama
>>
ISLAM ISLAM KRISTIAN BUDDHA HINDU LAIN-LAIN
[11] Warganegara
>>
WARGANEGARA MALAYSIA WARGANEGARA MALAYSIA PENDUDUK
TETAP PENDUDUK SEMENTARA BUKAN WARGANEGARA MALAYSIA
[12] Alamat
>>
[13] Bandar
>>
[14] Poskod
>>
[15] Negeri
>>
SELANGOR DARUL EHSAN JOHOR DARUL TAKZIM KEDAH DARUL
AMAN KELANTAN DARUL NAIM MELAKA NEGERI SEMBILAN DARUL
KHUSUS PAHANG DARUL
MAKMUR PERAK DARUL
RIDZUAN PERLIS INDRA
KAYANGAN PULAU PINANG SABAH SARAWAK SELANGOR DARUL EHSAN TERENGGANU
DARUL IMAN WILAYAH PERSEKUTUAN KUALA
LUMPUR WILAYAH PERSEKUTUAN
LABUAN WILAYAH PERSEKUTUAN
PUTRAJAYA BRUNEI INDONESIA SINGAPURA THAILAND LAIN-LAIN
NEGARA
[16] Negara
>>
MALAYSIA MALAYSIA BRUNEI
DARUSSALAM THAILAND INDONESIA SINGAPORE AFGHANISTAN ALBANIA ALGERIA AMERICAN
SAMOA ANDORRA ANGOLA ANTARCTICA ARGENTINA ARMENIA ARUBA ASCENSION AUSTRALIA AUSTRIA AZERBAIJAN BAHRAIN BANGLADESH BELARUS BELGIUM BELIZE BENIN BHUTAN BOLIVIA BOSNIA &
HERZEGOVINA BOTSWANA BRAZIL BULGARIA BURKINA
FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE
ISLANDS CENTRAL AFRICAN
REPUBLIC CHAD CHATHAM ISLAND (NEW ZEALAND) CHILE CHINA
(PRC) COCOS-KEELING
ISLANDS COLOMBIA COMOROS CONGO CONGO, DEM. REP. OF (FORMER ZAIRE) COOK ISLANDS COSTA
RICA CÔTE D'IVOIRE (IVORY
COAST) CROATIA CUBA CURAÇAO CYPRUS CZECH
REPUBLIC DENMARK DIEGO GARCIA DJIBOUTI EAST
TIMOR EASTER ISLAND ECUADOR EGYPT EL SALVADOR EQUATORIAL
GUINEA ERITREA ESTONIA ETHIOPIA FALKLAND ISLANDS
(MALVINAS) FAROE ISLANDS FIJI ISLANDS FINLAND FRANCE FRENCH ANTILLES FRENCH
GUIANA FRENCH POLYNESIA GABONESE REPUBLIC GAMBIA GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GUADELOUPE GUATEMALA GUINEA GUINEA-BISSAU GUYANA HAITI HONDURAS HONG
KONG HUNGARY ICELAND INDIA IRAN IRAQ IRELAND ISRAEL ITALY JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KOREA (NORTH) KOREA
(SOUTH) KUWAIT KYRGYZ REPUBLIC LAOS LATVIA LEBANON LESOTHO LIBERIA LIBYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAO MACEDONIA (FORMER
YUGOSLAV REP OF.) MADAGASCAR MALAWI MALDIVES MALI
REPUBLIC MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MAYOTTE
ISLAND MEXICO MICRONESIA, (FEDERAL STATES OF) MOLDOVA MONACO MONGOLIA MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NETHERLANDS
ANTILLES NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORFOLK
ISLAND NORWAY OMAN PAKISTAN PALAU PALESTINIAN
SETTLEMENTS PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES POLAND PORTUGAL QATAR RÉUNION ISLAND ROMANIA RUSSIA RWANDESE REPUBLIC SAN
MARINO SÃO TOMÉ AND
PRINCIPE SAUDI ARABIA SENEGAL SERBIA AND
MONTENEGRO SEYCHELLES
REPUBLIC SIERRA LEONE SLOVAK REPUBLIC SLOVENIA SOLOMON
ISLANDS SOMALI DEMOCRATIC
REPUBLIC SOUTH AFRICA SPAIN SRI
LANKA ST. HELENA ST. PIERRE & MIQUELON SUDAN SURINAME SWAZILAND SWEDEN SWITZERLAND SYRIA TAIWAN TAJIKISTAN TANZANIA TOGOLESE
REPUBLIC TOKELAU TONGA ISLANDS TUNISIA TURKEY TURKMENISTAN TUVALU UGANDA UKRAINE UNITED ARAB
EMIRATES UNITED KINGDOM UNITED STATES OF AMERICA URUGUAY UZBEKISTAN VANUATU VENEZUELA VIETNAM WAKE
ISLAND WALLIS AND FUTUNA
ISLANDS WESTERN SAMOA YEMEN ZAMBIA ZANZIBAR ZIMBABWE
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[18] No. K.P. Lama
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[19] No. Telefon
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[20] Telefon Bimbit
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[21] Email
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