Please fill the form completely!
Company Registration No./ Licence No./ MGJEA Memeber No./ Shop No.
Company Name/ Licence Name/ MGJEA Memeber Name/ Shop Name
Please try to remember this user name and password carefully.
You will have to use these to login to the portal again and checkout the status of your application.
You can include the recent passport photo and passport copy as the attachments.
To be filled by Agent
Agency Contact No.