Clinic Registration Form

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Step 1 of 3

Introduction

The Geran Digital PMKS Madani (GDPM) Grant is a government initiative aimed at supporting clinics in digitizing their healthcare services. Through this grant, clinics can adopt telemedicine services, health kiosks, and other digital solutions via the Sihat Xpress initiative. If your clinic is eligible, you can receive subsidized access to these digital tools to enhance your healthcare services, especially in rural areas.

IMPORTANT:

Sole proprietors only need to upload Borang B KKM.
Clinics registered with SSM (Suruhanjaya Syarikat Malaysia) must provide additional documents.

If your clinic has already applied for the GDPM Grant through another initiative, it is not eligible to apply again.

SECTION 1: Required Document Upload

Please upload the required documents according to your business entity type:

Latest one(1) month of financial statement (May block out the amount)

Click or drag a file to this area to upload.

For Sole Proprietor Clinics:

Please upload the required documents according to your business entity type:

Borang B KKM:

Click or drag a file to this area to upload.

For SSM-Registered Clinics (Limited Liability Partnership (LLP)/SSM Registered – Private Limited (Sdn Bhd)

Please upload the required documents according to your business entity type:

Form 9, Form24, Form49, Form 13 (if applicable), Form D (Partnership only – if applicable) & Form E (Partnership only – if applicable)

Click or drag files to this area to upload.You can upload up to 6 files.

SECTION 2: Company Details

1. Registered Business Name:

2. Business Registration Number (Only for SSM Registered Clinics):

3. Tax Identification Number (if applicable):

4. SST Number (if applicable) :

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5. Business Entity Type:

6. Date of Incorporation:

7. Gross Yearly Turnover:

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8. Number of Full-Time Employee:

9. Number of Part-Time Employee:

10. Address

Address line 1

11. Business Premise Type

City

State

Postal code

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12. License No. KKM Form B

13. License Date KKM Form B:

Upload Clinic's Borang B / Borang F

Click or drag a file to this area to upload.

Introduction

IMPORTANT:

SECTION 1: Required Document Upload

For Sole Proprietor Clinics:

For SSM-Registered Clinics (Limited Liability Partnership (LLP)/SSM Registered – Private Limited (Sdn Bhd)

SECTION 2: Company Details

SECTION 3: Applicant Details

SECTION 4: Package Options (Please choose one):

Section 5: Declaration