Rider Registration

Layla Rice Empire - LR(Wangsa Maju & Gombak Kuala Lumpur)

New Rider Registration

*Nick Name:

*IC Full Name:

*Email Address:

*Phone Number: (01xxxxxxxxx)

*Password:

*Confirm Password:

*IC:

*IC Image:

*Emergency Contact No.:

*Bank Name:

*Bank Account No.:

*Vehicle Type:

*Vehicle Model:

*Vehicle Color:

*Vehicle Image:

*Plate Number:

*License Expiry:

*License Image:

*Working Type?

Delivery Bag Image: (Please upload image if already have one)

*Do you have an active SOCSO?

Remarks:

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