EIS Form 7 - Employment Insurance System Application

This is a mandatory form that must be completed to apply for all benefits under EIS

A. Personal Information

A1. Full Name* (as per MyKad)

A2. NRIC No.(New)*

A3. NRIC No.(Old)/Psuedo

A4. Date Of Birth*

A5. Age*

A6. Race*

A7. Gender*

A8. Citizenship*

A9. Marital Status*

A10. Address*

A11. State*

A12. City*

A13. Postcode*

A14. Handphone No. (1)*

A15. Handphone No. (2)

A16. Telephone No. (Home)

A17. Telephone No. (Next of kin)
(to be contacted during an emergency)

A18. E-mail