NUMed - Agency Management Portal

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Section 1: Agency Information

Agency Name *

SST (%)*

SSM No

Agency Email *

Phone Code *

Agency Phone Number *

Link to Official Website

Covered Location/Recruitment Regions *

Section 2: Billing Address Information

Street *

City *

State/Province *

Zip/Postal Code *

Country *

Section 3: Banking Information

Bank Name *

Bank Account *

Bank Branch

Swift Code

Section 4: Supporting Documents

Agency Logo (PDF/JPEG/PNG)

Remove Select File Change

Agency Profile (PDF/JPEG/PNG) *

Remove Select File Change

SSM Corporate Information (PDF/JPEG/PNG)

Remove Select File Change

Section 5: Agency Owner Information

Name (as per IC/Passport) *

Preferred Name *

Email *

Phone Code *

Mobile Number *

Phone Code

Phone Number

Nationality *

Identification No *

Passport No *

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