Register New Mitra

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Registration Request

Identity Number*

ID Card

Email Address* (ex : name@email.com) Full Name* Address* Mitra Type* Contact No* (10-13 digit)

Min 1 Site Must Be Registered for the request

Sites Info

Site Name* Site Address*

Site Area (m²)* Site Ownership*

Site Images

Site Stock Capacity

Select Package Package Information

Site Type