LAD/NEAM/EA/EVP-F01 [1/2020]
Suruhanjaya Komunikasi dan Multimedia Malaysia Malaysian Communications and Multimedia Commission MCMC Tower 1, Jalan Impact, Cyber 6 63000 Cyberjaya, Selangor Darul Ehsan Tel: 603-86888000 Fax: 6 03-86881000 http://www.mcmc.gov.my
APPLICATION FORM FOR CERTIFICATION OF E-COMMERCE ENABLED WEBSITE
Please use separate annexure if there is insufficient space in the application form for the required information. (All required information are mandatory and shall be completed accordingly)
1. Applicant Details
i. Name of applicant (company) :
ii. Registration number of incorporation
:
iii. Address
(of principal place of business) : iv. Nature of business :
v. Income Tax file reference
number :
vi. Name of the contact person :
vii. Telephone :
viii. Fax or email :
2. Website Details
i. URL/address of the website (e.g.: .my, com.my, coop.my, biz.my, etc.)
:
ii. IPv4 and IPv6 addresses registered to the website (the website must accessible over IPv4 & IPv6)
:
iii. Name of web hosting company
(website must be hosted on a web server located in Malaysia)
:
iv. Type of e-commerce server software
(used for processing commercial transactions)
: Please tick ☒ whichever relevant
☐Magento
☐MartJAck
☐Shopify
☐WooCommerce
☐BigCommerce
☐OpenCart
☐Drupal Commerce
☐Volusion
☐OsCommerce
☐SimpleCart
☐Squarespace
☐Other (please specify):
LAD/NEAM/EA/EVP-F01 [1/2020]
Page 2 of 3 2. Website Details
v. List of functionalities of server software
: Please tick ☒ whichever relevant
☐Product display
☐e-shopping cart
☐Order management system
☐Inventory management
☐Back end calculation for display
☐Other (please specify):
vi. Method/s of payment and collection
(used for commercial transactions)
: Please tick ☒ whichever relevant
☐Ipay88
☐Paypal
☐Bank transfer
☐MOLPay
☐ EGHL
☐ SenangPay
☐ Online banking/bank transfer
☐ E-wallet
☐Other (please specify):
vii. Type of security capabilities used (to provide evidence such as SSL certificate, DNSSEC etc.)
: Please tick ☒ whichever relevant
☐ SSL certificate ☐ DNSSEC (mandatory)
☐ Other (please specify):
3. Website Flow
i. Process flow of the entire commercial transaction (from the time customer browse the Applicant’s web site for product information to the placement of order and delivery of the goods or services)
:
ii. A copy of all relevant web pages
:
iii. A temporary access id (if
necessary) :
LAD/NEAM/EA/EVP-F01 [1/2020]
Page 3 of 3 4. Declaration
(If the Applicant is not an individual, the declaration must be signed by two directors/partners or one director/ partner and one secretary)
I hereby certify and declare that all the particulars furnished in this form are true and correct.
Signature:
Name:
Designation:
Company seal:
Date:
I hereby certify and declare that all the particulars furnished in this form are true and correct.
Signature:
Name:
Designation:
Company seal:
Date:
FOR MCMC USE ONLY
File Reference:
Fee paid:
Cheque or Bank in slip no.:
Receipt no. / date:
