| EMPLOYER DETAILS |
| Full Name of Employer (As shown in your License): |
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| Full Address of Employer (As shown in your License): |
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| Quota License No (eg: DH 43511): |
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| IC No. of the Employer: |
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| Phone No: |
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| Email Address: |
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| Religion: |
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| Type of house you have: | Bungalow
Flat/Apartment
Kg Ayer
Terrace
Perpindahan
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| Fill in the number of people living in your house below? |
| Adult? |
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| Teenager Age Between 13 to 18 years old? |
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| Children Age Between 5 to 12 years old? |
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| Children Age Between 1 to 4 years old? |
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| Baby Age below 1 year old? |
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| Are you willing to give day off to your housemaid? | Yes
No
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| HOUSEMAID DETAILS |
Code No: |
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| What works do you want maid to do? | Take care of my baby
Take care of my children
Take care of my elderly
Cleaning House
Cooking
Gardening
Washing Clothes
Washing Car
Ironing
Feeding Pets
Others
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| If Feeding Pets is TICK, please fill in below field with what type of pet do you have, how many and what sort of work you want the maid to do for them. |
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| How many rooms in your house? |
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| Maid's Room: | Separate Room
Sharing With Children
No Room
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How old is your children?
Please list out all the name and age of your children. |
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| Please List Any Special Care or Attention Needed For Employer or Family Members |
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| ANSWER BELOW QUESTIONS |
I know the salary deduction for the maid I choose is: |
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| The salary of the maid I choose is: |
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| I will buy the Insurance of my maid: |
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| I will apply the Green Card for my maid: |
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| I have read the terms and conditions as stated in 'CONDITIONS' section. And I am: |
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