MALAYSIAN BIOTECHNOLOGY CORPORATION SDN BHD  
BioNexus Pre-Application Form  
 
    1. Applicant Background
Name of Applicant *
Has any company been incorporated? Yes No *
If "Yes", please provide Company Name *
Date of Incorporation *
Equity Participation
 Malaysian Foreign *
 
    2. Proposed Activities / Product
Industry
(please tick all that apply)		 Agriculture Healthcare Industrial *
BioNexus Proposed Activities
(please describe in max 2000 words)		 *
Any R&D Undertaken? Yes No *
BioNexus Proposed R&D Activities
(please describe in max 2000 words)		 *
 
    3. Applicant / Company Contact Information
Title  

*
Full Name   *
Designation   *
Address   *
Street  
City *
Postcode *
State *
Country *
Website (If any)    
Contact Details Office Country Code    Area Code      Office Phone No.
+       --           --      		*
  Fax Country Code    Area Code      Fax No.
+      --            --      		*
  Mobile Country Code    Area Code      Mobile Phone No.
+      --            --      		*
  Email *
Submission Date  
 
    PART  4: Verification
 
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    Disclaimer
    I,hereby declare that all information provided & submitted to Malaysian Biotechnology Corporation is true and correct     at the point of submission.
    I Agree *
    * Required