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* Denotes a required information
 
Please provide a unique username and password in order to gain access to the MDNR system. You need to retype your password to gain access to the system.
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Username and Password
Username *
 
Password
*
 
Confirm Password
*
 
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Establishment Detail
Name of Establishment*
Business Registration Number *
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Particulars of Authorized Person for the Establishment
Name *
Position
Person ID *  
Address *
Post Code  
City *
Mobile *
e.g (5xxxxxxxx)
Fax *  
Email *
 
Please ensure all information are correct when filling up the form. Click the icon "Create Account" to create account.
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