{"id":26,"date":"2024-01-29T21:08:13","date_gmt":"2024-01-29T13:08:13","guid":{"rendered":"https:\/\/app.nh.my\/form\/?page_id=26"},"modified":"2025-01-17T12:58:58","modified_gmt":"2025-01-17T04:58:58","slug":"permohonan","status":"publish","type":"page","link":"https:\/\/app.nh.my\/form\/permohonan\/","title":{"rendered":"Permohonan Kemasukan Pelajar"},"content":{"rendered":"<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_1' ><div id='gf_1' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">Permohonan Kemasukan Pelajar<\/h3>\n                            <p class='gform_description'>Borang Permohonan Kemasukan Pelajar Sesi Baru SMA Nahdhah Hasanah<\/p>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>Bertanda &quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; harus diisi<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_1' id='gform_1'  action='\/form\/wp-json\/wp\/v2\/pages\/26#gf_1' data-formid='1' >\n                        <div class='gform-body gform_body'><div id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_above'><div id=\"field_1_72\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_72\"><hr><b>PERHATIAN:<\/b><br>\n&#8211; Semua Huruf Abjad Harus <b>TULISAN BESAR<\/b>.<br>\n&#8211; Setiap permohonan akan dikenakan Yuran Proses sebanyak <b>RM10<\/b><br>\n&#8211; Sila sediakan dokumen sokongan:<br>\n1. Salinan kad pengenalan atau passport pelajar.<br>\n2. Salinan kad pengenalan \/ passport ibu bapa \/ penjaga.<br>\n3. Salinan sijil \/ surat berhenti sekolah.<hr><\/div><fieldset id=\"field_1_20\"  class=\"gfield gfield--type-post_image gfield--width-half gambar-pelajar gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_20\"><legend class='gfield_label gform-field-label'  >Gambar Pelajar<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_1_20'><b>(Ukuran Passport)<\/b><br>Disarankan muat naik saiz  gambar min. 500&#215;500 pixel<\/div><div class='ginput_complex ginput_container ginput_container_post_image gform-grid-row'><span class='ginput_full gform-grid-col'><input name='input_20' id='input_1_20' type='file' class='large'  aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"extensions_message_1_20 gfield_description_1_20\" \/><span id='extensions_message_1_20' class='gfield_description gform_fileupload_rules'>Jenis dokumen dibenarkan: jpg, jpeg, png, gif.<\/span><\/span><\/div><\/fieldset><div id=\"field_1_102\"  class=\"gfield gfield--type-html gfield--width-half divbox gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_102\"><center><img decoding=\"async\" src=\"https:\/\/app.nh.my\/form\/wp-content\/uploads\/2024\/02\/img-placeholder.jpg\" width=\"150px\"><br>\n<span style=\"font-size:12px\"><b>Perhatian:<\/b><br>\n&#8211; Gambar boleh diambil terus dari kamera phone dan mesti kelihatan jelas.<br>\n&#8211; Gambar mesti berlatarkan warna putih atau biru.<br><\/span><\/center><\/div><div id=\"field_1_74\"  class=\"gfield gfield--type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_74\"><label class='gfield_label gform-field-label' for='input_1_74' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_74'>Email mudah untuk berhubung<\/div><div class='ginput_container ginput_container_email'>\n                            <input name='input_74' id='input_1_74' type='text' value='' class='large'   placeholder='cth: email@gmail.com' aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_1_74\" \/>\n                        <\/div><\/div><div id=\"field_1_22\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_22\"><h3 class=\"gsection_title\">(A) MAKLUMAT PELAJAR<\/h3><\/div><div id=\"field_1_6\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_6\"><label class='gfield_label gform-field-label' for='input_1_6' >Nama Pemohon<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_6'>(Seperti kad pengenalan\/Passport)<\/div><div class='ginput_container ginput_container_text'><input name='input_6' id='input_1_6' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_6\"  placeholder='NAMA PELAJAR' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_78\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_78\"><label class='gfield_label gform-field-label' for='input_1_78' >No. Kad Pengenalan \/ Passport<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_78'>(Tanpa ruang\/sengkang)<\/div><div class='ginput_container ginput_container_text'><input name='input_78' id='input_1_78' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_78\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_1_10\"  class=\"gfield gfield--type-date gfield--input-type-datedropdown gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_10\"><legend class='gfield_label gform-field-label'  >Tarikh Lahir<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div id='input_1_10' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_1_10_2_container'><select name='input_10[]' id='input_1_10_2'   aria-required='true'  ><option value=''>Hari<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_1_10_1_container'><select name='input_10[]' id='input_1_10_1'   aria-required='true'  ><option value=''>Bulan<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_1_10_3_container'><select name='input_10[]' id='input_1_10_3'   aria-required='true'  ><option value=''>Tahun<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/fieldset><div id=\"field_1_11\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_11\"><label class='gfield_label gform-field-label' for='input_1_11' >Tempat Lahir<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_11'>(Sertakan Nama Hospital &#038; Negeri)<\/div><div class='ginput_container ginput_container_text'><input name='input_11' id='input_1_11' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_11\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_12\"  class=\"gfield gfield--type-number gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_12\"><label class='gfield_label gform-field-label' for='input_1_12' >Umur<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_12' id='input_1_12' type='text'    value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_1_14\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_14\"><legend class='gfield_label gform-field-label'  >Jantina<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_14'>\n\t\t\t<div class='gchoice gchoice_1_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Lelaki' checked='checked' id='choice_1_14_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_14_0' id='label_1_14_0' class='gform-field-label gform-field-label--type-inline'>Lelaki<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Perempuan'  id='choice_1_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_14_1' id='label_1_14_1' class='gform-field-label gform-field-label--type-inline'>Perempuan<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_87\"  class=\"gfield gfield--type-countrywisestate gfield--input-type-countrywisestate gfield--width-full gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_87\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Warganegara<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container has_state ginput_container_address' name='country_state_fliter' id='input_1_87' >           \n            <span class='ginput_left address_country ginput_address_country' id='input_1_87_1_container' ><select class='large' data-show-subtext='true' data-live-search='true' name='input_87.1' id='input_1_87_1' class=\"gfield_select\"    ><option value=\"\">Select Country<\/option><option value='Afghanistan'>Afghanistan<\/option><option value='Aland'>Aland<\/option><option value='Albania'>Albania<\/option><option value='Algeria'>Algeria<\/option><option value='American Samoa'>American Samoa<\/option><option value='Andorra'>Andorra<\/option><option value='Angola'>Angola<\/option><option value='Anguilla'>Anguilla<\/option><option value='Antarctica'>Antarctica<\/option><option value='Antigua and Barbuda'>Antigua and Barbuda<\/option><option value='Argentina'>Argentina<\/option><option value='Armenia'>Armenia<\/option><option value='Aruba'>Aruba<\/option><option value='Ascension'>Ascension<\/option><option value='Australia'>Australia<\/option><option value='Austria'>Austria<\/option><option value='Azerbaijan'>Azerbaijan<\/option><option value='Bahamas'>Bahamas<\/option><option value='Bahrain'>Bahrain<\/option><option value='Bangladesh'>Bangladesh<\/option><option value='Barbados'>Barbados<\/option><option value='Belarus'>Belarus<\/option><option value='Belgium'>Belgium<\/option><option value='Belize'>Belize<\/option><option value='Benin'>Benin<\/option><option value='Bermuda'>Bermuda<\/option><option value='Bhutan'>Bhutan<\/option><option value='Bolivia'>Bolivia<\/option><option value='Bosnia and Herzegovina'>Bosnia and Herzegovina<\/option><option value='Botswana'>Botswana<\/option><option value='Bouvet Island'>Bouvet Island<\/option><option value='Brazil'>Brazil<\/option><option value='British Indian Ocean Territory'>British Indian Ocean Territory<\/option><option value='British Virgin Islands'>British Virgin Islands<\/option><option value='Brunei'>Brunei<\/option><option value='Bulgaria'>Bulgaria<\/option><option value='Burkina Faso'>Burkina Faso<\/option><option value='Burundi'>Burundi<\/option><option value='Cambodia'>Cambodia<\/option><option value='Cameroon'>Cameroon<\/option><option value='Canada'>Canada<\/option><option value='Cape Verde'>Cape Verde<\/option><option value='Cayman Islands'>Cayman Islands<\/option><option value='Central African Republic'>Central African Republic<\/option><option value='Chad'>Chad<\/option><option value='Chile'>Chile<\/option><option value='China'>China<\/option><option value='Christmas Island'>Christmas Island<\/option><option value='Cocos (Keeling) Islands'>Cocos (Keeling) Islands<\/option><option value='Colombia'>Colombia<\/option><option value='Comoros'>Comoros<\/option><option value='Congo'>Congo<\/option><option value='Congo (DRC)'>Congo (DRC)<\/option><option value='Cook Islands'>Cook Islands<\/option><option value='Costa Rica'>Costa Rica<\/option><option value='Cote d'Ivoire'>Cote d&#8217;Ivoire<\/option><option value='Croatia'>Croatia<\/option><option value='Cuba'>Cuba<\/option><option value='Cyprus'>Cyprus<\/option><option value='Czech Republic'>Czech Republic<\/option><option value='Denmark'>Denmark<\/option><option value='Djibouti'>Djibouti<\/option><option value='Dominica'>Dominica<\/option><option value='Dominican Republic'>Dominican Republic<\/option><option value='Ecuador'>Ecuador<\/option><option value='Egypt'>Egypt<\/option><option value='El Salvador'>El Salvador<\/option><option value='Equatorial Guinea'>Equatorial Guinea<\/option><option value='Eritrea'>Eritrea<\/option><option value='Estonia'>Estonia<\/option><option value='Ethiopia'>Ethiopia<\/option><option value='Falkland Islands (Islas Malvinas)'>Falkland Islands (Islas Malvinas)<\/option><option value='Faroe Islands'>Faroe Islands<\/option><option value='Fiji'>Fiji<\/option><option value='Finland'>Finland<\/option><option value='France'>France<\/option><option value='French Guiana'>French Guiana<\/option><option value='French Polynesia'>French Polynesia<\/option><option value='French Southern and Antarctic Lands'>French Southern and Antarctic Lands<\/option><option value='Gabon'>Gabon<\/option><option value='Gambia'>Gambia<\/option><option value='Georgia'>Georgia<\/option><option value='Germany'>Germany<\/option><option value='Ghana'>Ghana<\/option><option value='Gibraltar'>Gibraltar<\/option><option value='Greece'>Greece<\/option><option value='Greenland'>Greenland<\/option><option value='Grenada'>Grenada<\/option><option value='Guadeloupe'>Guadeloupe<\/option><option value='Guam'>Guam<\/option><option value='Guatemala'>Guatemala<\/option><option value='Guernsey'>Guernsey<\/option><option value='Guinea'>Guinea<\/option><option value='Guinea-Bissau'>Guinea-Bissau<\/option><option value='Guyana'>Guyana<\/option><option value='Haiti'>Haiti<\/option><option value='Heard Island and McDonald Islands'>Heard Island and McDonald Islands<\/option><option value='Honduras'>Honduras<\/option><option value='Hong Kong'>Hong Kong<\/option><option value='Hungary'>Hungary<\/option><option value='Iceland'>Iceland<\/option><option value='India'>India<\/option><option value='Indonesia'>Indonesia<\/option><option value='Iran'>Iran<\/option><option value='Iraq'>Iraq<\/option><option value='Ireland'>Ireland<\/option><option value='Isle of Man'>Isle of Man<\/option><option value='Israel'>Israel<\/option><option value='Italy'>Italy<\/option><option value='Jamaica'>Jamaica<\/option><option value='Japan'>Japan<\/option><option value='Jersey'>Jersey<\/option><option value='Jordan'>Jordan<\/option><option value='Kazakhstan'>Kazakhstan<\/option><option value='Kenya'>Kenya<\/option><option value='Kiribati'>Kiribati<\/option><option value='Korea (North Korea)'>Korea (North Korea)<\/option><option value='Korea (South Korea)'>Korea (South Korea)<\/option><option value='Kosovo'>Kosovo<\/option><option value='Kuwait'>Kuwait<\/option><option value='Kyrgyzstan'>Kyrgyzstan<\/option><option value='Laos'>Laos<\/option><option value='Latvia'>Latvia<\/option><option value='Lebanon'>Lebanon<\/option><option value='Lesotho'>Lesotho<\/option><option value='Liberia'>Liberia<\/option><option value='Libya'>Libya<\/option><option value='Liechtenstein'>Liechtenstein<\/option><option value='Lithuania'>Lithuania<\/option><option value='Luxembourg'>Luxembourg<\/option><option value='Macau'>Macau<\/option><option value='Macedonia'>Macedonia<\/option><option value='Madagascar'>Madagascar<\/option><option value='Malawi'>Malawi<\/option><option value='Malaysia' selected>Malaysia<\/option><option value='Maldives'>Maldives<\/option><option value='Mali'>Mali<\/option><option value='Malta'>Malta<\/option><option value='Marshall Islands'>Marshall Islands<\/option><option value='Martinique'>Martinique<\/option><option value='Mauritania'>Mauritania<\/option><option value='Mauritius'>Mauritius<\/option><option value='Mayotte'>Mayotte<\/option><option value='Mexico'>Mexico<\/option><option value='Micronesia'>Micronesia<\/option><option value='Moldova'>Moldova<\/option><option value='Monaco'>Monaco<\/option><option value='Mongolia'>Mongolia<\/option><option value='Montenegro'>Montenegro<\/option><option value='Montserrat'>Montserrat<\/option><option value='Morocco'>Morocco<\/option><option value='Mozambique'>Mozambique<\/option><option value='Myanmar (Burma)'>Myanmar (Burma)<\/option><option value='Namibia'>Namibia<\/option><option value='Nauru'>Nauru<\/option><option value='Nepal'>Nepal<\/option><option value='Netherlands'>Netherlands<\/option><option value='Netherlands Antilles'>Netherlands Antilles<\/option><option value='New Caledonia'>New Caledonia<\/option><option value='New Zealand'>New Zealand<\/option><option value='Nicaragua'>Nicaragua<\/option><option value='Niger'>Niger<\/option><option value='Nigeria'>Nigeria<\/option><option value='Niue'>Niue<\/option><option value='Northern Mariana Islands'>Northern Mariana Islands<\/option><option value='Norway'>Norway<\/option><option value='Oman'>Oman<\/option><option value='Pakistan'>Pakistan<\/option><option value='Palau'>Palau<\/option><option value='Palestinian Territories (Gaza Strip and West Bank)'>Palestinian Territories (Gaza Strip and West Bank)<\/option><option value='Panama'>Panama<\/option><option value='Papua New Guinea'>Papua New Guinea<\/option><option value='Paraguay'>Paraguay<\/option><option value='Peru'>Peru<\/option><option value='Philippines'>Philippines<\/option><option value='Pitcairn Islands'>Pitcairn Islands<\/option><option value='Poland'>Poland<\/option><option value='Portugal'>Portugal<\/option><option value='Puerto Rico'>Puerto Rico<\/option><option value='Qatar'>Qatar<\/option><option value='Reunion'>Reunion<\/option><option value='Romania'>Romania<\/option><option value='Russia'>Russia<\/option><option value='Rwanda'>Rwanda<\/option><option value='Saint Helena'>Saint Helena<\/option><option value='Saint Kitts and Nevis'>Saint Kitts and Nevis<\/option><option value='Saint Lucia'>Saint Lucia<\/option><option value='Saint Pierre and Miquelon'>Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines'>Saint Vincent and the Grenadines<\/option><option value='Samoa'>Samoa<\/option><option value='San Marino'>San Marino<\/option><option value='Sao Tome and Principe'>Sao Tome and Principe<\/option><option value='Saudi Arabia'>Saudi Arabia<\/option><option value='Senegal'>Senegal<\/option><option value='Serbia'>Serbia<\/option><option value='Seychelles'>Seychelles<\/option><option value='Sierra Leone'>Sierra Leone<\/option><option value='Singapore'>Singapore<\/option><option value='Slovakia'>Slovakia<\/option><option value='Slovenia'>Slovenia<\/option><option value='Solomon Islands'>Solomon Islands<\/option><option value='Somalia'>Somalia<\/option><option value='South Africa'>South Africa<\/option><option value='South Georgia and the South Sandwich Islands'>South Georgia and the South Sandwich Islands<\/option><option value='Spain'>Spain<\/option><option value='Sri Lanka'>Sri Lanka<\/option><option value='Sudan'>Sudan<\/option><option value='Suriname'>Suriname<\/option><option value='Svalbard'>Svalbard<\/option><option value='Swaziland'>Swaziland<\/option><option value='Sweden'>Sweden<\/option><option value='Switzerland'>Switzerland<\/option><option value='Syria'>Syria<\/option><option value='Taiwan'>Taiwan<\/option><option value='Tajikistan'>Tajikistan<\/option><option value='Tanzania'>Tanzania<\/option><option value='Thailand'>Thailand<\/option><option value='Timor-Leste (East Timor)'>Timor-Leste (East Timor)<\/option><option value='Togo'>Togo<\/option><option value='Tokelau'>Tokelau<\/option><option value='Tonga'>Tonga<\/option><option value='Trinidad and Tobago'>Trinidad and Tobago<\/option><option value='Tristan da Cunha'>Tristan da Cunha<\/option><option value='Tunisia'>Tunisia<\/option><option value='Turkey'>Turkey<\/option><option value='Turkmenistan'>Turkmenistan<\/option><option value='Turks and Caicos Islands'>Turks and Caicos Islands<\/option><option value='Tuvalu'>Tuvalu<\/option><option value='U.S. Virgin Islands'>U.S. Virgin Islands<\/option><option value='Uganda'>Uganda<\/option><option value='Ukraine'>Ukraine<\/option><option value='United Arab Emirates'>United Arab Emirates<\/option><option value='United Kingdom'>United Kingdom<\/option><option value='United States'>United States<\/option><option value='United States Minor Outlying Islands'>United States Minor Outlying Islands<\/option><option value='Uruguay'>Uruguay<\/option><option value='Uzbekistan'>Uzbekistan<\/option><option value='Vanuatu'>Vanuatu<\/option><option value='Vatican City'>Vatican City<\/option><option value='Venezuela'>Venezuela<\/option><option value='Vietnam'>Vietnam<\/option><option value='Wallis and Futuna'>Wallis and Futuna<\/option><option value='Western Sahara'>Western Sahara<\/option><option value='Yemen'>Yemen<\/option><option value='Zambia'>Zambia<\/option><option value='Zimbabwe'>Zimbabwe<\/option><\/select><label for='input_1_87_1' id='input_1_87_1_label' class='hidden_sub_label'>Country<\/label><\/span><input type='hidden' class='gform_hidden' name='input_87.2' id='input_1_87_2' value='Malaysia'\/><div class='gf_clear gf_clear_complex'><\/div><\/div><\/fieldset><div id=\"field_1_16\"  class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_16\"><label class='gfield_label gform-field-label' for='input_1_16' >Bangsa<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_16' id='input_1_16' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Melayu' selected='selected'>Melayu<\/option><option value='Siam' >Siam<\/option><option value='Arab' >Arab<\/option><option value='Cina' >Cina<\/option><option value='India' >India<\/option><option value='Lain-lain' >Lain-lain<\/option><\/select><\/div><\/div><fieldset id=\"field_1_18\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_18\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Alamat Surat Menyurat<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address gform-grid-row' id='input_1_18' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_1_18_1_container' >\n                                        <input type='text' name='input_18.1' id='input_1_18_1' value=''   placeholder='Alamat Penuh' aria-required='true'    \/>\n                                        <label for='input_1_18_1' id='input_1_18_1_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Alamat<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_1_18_3_container' >\n                                    <input type='text' name='input_18.3' id='input_1_18_3' value=''   placeholder='Bandar\/Daerah' aria-required='true'    \/>\n                                    <label for='input_1_18_3' id='input_1_18_3_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Bandar<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_18.4' id='input_1_18_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_1_18_5_container' >\n                                    <input type='text' name='input_18.5' id='input_1_18_5' value=''   placeholder='Poskod' aria-required='true'    \/>\n                                    <label for='input_1_18_5' id='input_1_18_5_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Poskod<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_18.6' id='input_1_18_6' value='Malaysia' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_1_73\"  class=\"gfield gfield--type-countrywisestate gfield--input-type-countrywisestate gfield--width-full gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_above hidden_label gfield_visibility_visible\"  data-js-reload=\"field_1_73\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Alamat 2<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container has_state has_country ginput_container_address' name='country_state_fliter' id='input_1_73' >           \n            <span class='ginput_left address_country ginput_address_country' id='input_1_73_1_container' ><select class='large' data-show-subtext='true' data-live-search='true' name='input_73.1' id='input_1_73_1' class=\"gfield_select\"    ><option name='country_input_placeholders' value='Negara'>Negara<\/option><option value='Afghanistan'>Afghanistan<\/option><option value='Aland'>Aland<\/option><option value='Albania'>Albania<\/option><option value='Algeria'>Algeria<\/option><option value='American Samoa'>American Samoa<\/option><option value='Andorra'>Andorra<\/option><option value='Angola'>Angola<\/option><option value='Anguilla'>Anguilla<\/option><option value='Antarctica'>Antarctica<\/option><option value='Antigua and Barbuda'>Antigua and Barbuda<\/option><option value='Argentina'>Argentina<\/option><option value='Armenia'>Armenia<\/option><option value='Aruba'>Aruba<\/option><option value='Ascension'>Ascension<\/option><option value='Australia'>Australia<\/option><option value='Austria'>Austria<\/option><option value='Azerbaijan'>Azerbaijan<\/option><option value='Bahamas'>Bahamas<\/option><option value='Bahrain'>Bahrain<\/option><option value='Bangladesh'>Bangladesh<\/option><option value='Barbados'>Barbados<\/option><option value='Belarus'>Belarus<\/option><option value='Belgium'>Belgium<\/option><option value='Belize'>Belize<\/option><option value='Benin'>Benin<\/option><option value='Bermuda'>Bermuda<\/option><option value='Bhutan'>Bhutan<\/option><option value='Bolivia'>Bolivia<\/option><option value='Bosnia and Herzegovina'>Bosnia and Herzegovina<\/option><option value='Botswana'>Botswana<\/option><option value='Bouvet Island'>Bouvet Island<\/option><option value='Brazil'>Brazil<\/option><option value='British Indian Ocean Territory'>British Indian Ocean Territory<\/option><option value='British Virgin Islands'>British Virgin Islands<\/option><option value='Brunei'>Brunei<\/option><option value='Bulgaria'>Bulgaria<\/option><option value='Burkina Faso'>Burkina Faso<\/option><option value='Burundi'>Burundi<\/option><option value='Cambodia'>Cambodia<\/option><option value='Cameroon'>Cameroon<\/option><option value='Canada'>Canada<\/option><option value='Cape Verde'>Cape Verde<\/option><option value='Cayman Islands'>Cayman Islands<\/option><option value='Central African Republic'>Central African Republic<\/option><option value='Chad'>Chad<\/option><option value='Chile'>Chile<\/option><option value='China'>China<\/option><option value='Christmas Island'>Christmas Island<\/option><option value='Cocos (Keeling) Islands'>Cocos (Keeling) Islands<\/option><option value='Colombia'>Colombia<\/option><option value='Comoros'>Comoros<\/option><option value='Congo'>Congo<\/option><option value='Congo (DRC)'>Congo (DRC)<\/option><option value='Cook Islands'>Cook Islands<\/option><option value='Costa Rica'>Costa Rica<\/option><option value='Cote d'Ivoire'>Cote d&#8217;Ivoire<\/option><option value='Croatia'>Croatia<\/option><option value='Cuba'>Cuba<\/option><option value='Cyprus'>Cyprus<\/option><option value='Czech Republic'>Czech Republic<\/option><option value='Denmark'>Denmark<\/option><option value='Djibouti'>Djibouti<\/option><option value='Dominica'>Dominica<\/option><option value='Dominican Republic'>Dominican Republic<\/option><option value='Ecuador'>Ecuador<\/option><option value='Egypt'>Egypt<\/option><option value='El Salvador'>El Salvador<\/option><option value='Equatorial Guinea'>Equatorial Guinea<\/option><option value='Eritrea'>Eritrea<\/option><option value='Estonia'>Estonia<\/option><option value='Ethiopia'>Ethiopia<\/option><option value='Falkland Islands (Islas Malvinas)'>Falkland Islands (Islas Malvinas)<\/option><option value='Faroe Islands'>Faroe Islands<\/option><option value='Fiji'>Fiji<\/option><option value='Finland'>Finland<\/option><option value='France'>France<\/option><option value='French Guiana'>French Guiana<\/option><option value='French Polynesia'>French Polynesia<\/option><option value='French Southern and Antarctic Lands'>French Southern and Antarctic Lands<\/option><option value='Gabon'>Gabon<\/option><option value='Gambia'>Gambia<\/option><option value='Georgia'>Georgia<\/option><option value='Germany'>Germany<\/option><option value='Ghana'>Ghana<\/option><option value='Gibraltar'>Gibraltar<\/option><option value='Greece'>Greece<\/option><option value='Greenland'>Greenland<\/option><option value='Grenada'>Grenada<\/option><option value='Guadeloupe'>Guadeloupe<\/option><option value='Guam'>Guam<\/option><option value='Guatemala'>Guatemala<\/option><option value='Guernsey'>Guernsey<\/option><option value='Guinea'>Guinea<\/option><option value='Guinea-Bissau'>Guinea-Bissau<\/option><option value='Guyana'>Guyana<\/option><option value='Haiti'>Haiti<\/option><option value='Heard Island and McDonald Islands'>Heard Island and McDonald Islands<\/option><option value='Honduras'>Honduras<\/option><option value='Hong Kong'>Hong Kong<\/option><option value='Hungary'>Hungary<\/option><option value='Iceland'>Iceland<\/option><option value='India'>India<\/option><option value='Indonesia'>Indonesia<\/option><option value='Iran'>Iran<\/option><option value='Iraq'>Iraq<\/option><option value='Ireland'>Ireland<\/option><option value='Isle of Man'>Isle of Man<\/option><option value='Israel'>Israel<\/option><option value='Italy'>Italy<\/option><option value='Jamaica'>Jamaica<\/option><option value='Japan'>Japan<\/option><option value='Jersey'>Jersey<\/option><option value='Jordan'>Jordan<\/option><option value='Kazakhstan'>Kazakhstan<\/option><option value='Kenya'>Kenya<\/option><option value='Kiribati'>Kiribati<\/option><option value='Korea (North Korea)'>Korea (North Korea)<\/option><option value='Korea (South Korea)'>Korea (South Korea)<\/option><option value='Kosovo'>Kosovo<\/option><option value='Kuwait'>Kuwait<\/option><option value='Kyrgyzstan'>Kyrgyzstan<\/option><option value='Laos'>Laos<\/option><option value='Latvia'>Latvia<\/option><option value='Lebanon'>Lebanon<\/option><option value='Lesotho'>Lesotho<\/option><option value='Liberia'>Liberia<\/option><option value='Libya'>Libya<\/option><option value='Liechtenstein'>Liechtenstein<\/option><option value='Lithuania'>Lithuania<\/option><option value='Luxembourg'>Luxembourg<\/option><option value='Macau'>Macau<\/option><option value='Macedonia'>Macedonia<\/option><option value='Madagascar'>Madagascar<\/option><option value='Malawi'>Malawi<\/option><option value='Malaysia' selected>Malaysia<\/option><option value='Maldives'>Maldives<\/option><option value='Mali'>Mali<\/option><option value='Malta'>Malta<\/option><option value='Marshall Islands'>Marshall Islands<\/option><option value='Martinique'>Martinique<\/option><option value='Mauritania'>Mauritania<\/option><option value='Mauritius'>Mauritius<\/option><option value='Mayotte'>Mayotte<\/option><option value='Mexico'>Mexico<\/option><option value='Micronesia'>Micronesia<\/option><option value='Moldova'>Moldova<\/option><option value='Monaco'>Monaco<\/option><option value='Mongolia'>Mongolia<\/option><option value='Montenegro'>Montenegro<\/option><option value='Montserrat'>Montserrat<\/option><option value='Morocco'>Morocco<\/option><option value='Mozambique'>Mozambique<\/option><option value='Myanmar (Burma)'>Myanmar (Burma)<\/option><option value='Namibia'>Namibia<\/option><option value='Nauru'>Nauru<\/option><option value='Nepal'>Nepal<\/option><option value='Netherlands'>Netherlands<\/option><option value='Netherlands Antilles'>Netherlands Antilles<\/option><option value='New Caledonia'>New Caledonia<\/option><option value='New Zealand'>New Zealand<\/option><option value='Nicaragua'>Nicaragua<\/option><option value='Niger'>Niger<\/option><option value='Nigeria'>Nigeria<\/option><option value='Niue'>Niue<\/option><option value='Northern Mariana Islands'>Northern Mariana Islands<\/option><option value='Norway'>Norway<\/option><option value='Oman'>Oman<\/option><option value='Pakistan'>Pakistan<\/option><option value='Palau'>Palau<\/option><option value='Palestinian Territories (Gaza Strip and West Bank)'>Palestinian Territories (Gaza Strip and West Bank)<\/option><option value='Panama'>Panama<\/option><option value='Papua New Guinea'>Papua New Guinea<\/option><option value='Paraguay'>Paraguay<\/option><option value='Peru'>Peru<\/option><option value='Philippines'>Philippines<\/option><option value='Pitcairn Islands'>Pitcairn Islands<\/option><option value='Poland'>Poland<\/option><option value='Portugal'>Portugal<\/option><option value='Puerto Rico'>Puerto Rico<\/option><option value='Qatar'>Qatar<\/option><option value='Reunion'>Reunion<\/option><option value='Romania'>Romania<\/option><option value='Russia'>Russia<\/option><option value='Rwanda'>Rwanda<\/option><option value='Saint Helena'>Saint Helena<\/option><option value='Saint Kitts and Nevis'>Saint Kitts and Nevis<\/option><option value='Saint Lucia'>Saint Lucia<\/option><option value='Saint Pierre and Miquelon'>Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines'>Saint Vincent and the Grenadines<\/option><option value='Samoa'>Samoa<\/option><option value='San Marino'>San Marino<\/option><option value='Sao Tome and Principe'>Sao Tome and Principe<\/option><option value='Saudi Arabia'>Saudi Arabia<\/option><option value='Senegal'>Senegal<\/option><option value='Serbia'>Serbia<\/option><option value='Seychelles'>Seychelles<\/option><option value='Sierra Leone'>Sierra Leone<\/option><option value='Singapore'>Singapore<\/option><option value='Slovakia'>Slovakia<\/option><option value='Slovenia'>Slovenia<\/option><option value='Solomon Islands'>Solomon Islands<\/option><option value='Somalia'>Somalia<\/option><option value='South Africa'>South Africa<\/option><option value='South Georgia and the South Sandwich Islands'>South Georgia and the South Sandwich Islands<\/option><option value='Spain'>Spain<\/option><option value='Sri Lanka'>Sri Lanka<\/option><option value='Sudan'>Sudan<\/option><option value='Suriname'>Suriname<\/option><option value='Svalbard'>Svalbard<\/option><option value='Swaziland'>Swaziland<\/option><option value='Sweden'>Sweden<\/option><option value='Switzerland'>Switzerland<\/option><option value='Syria'>Syria<\/option><option value='Taiwan'>Taiwan<\/option><option value='Tajikistan'>Tajikistan<\/option><option value='Tanzania'>Tanzania<\/option><option value='Thailand'>Thailand<\/option><option value='Timor-Leste (East Timor)'>Timor-Leste (East Timor)<\/option><option value='Togo'>Togo<\/option><option value='Tokelau'>Tokelau<\/option><option value='Tonga'>Tonga<\/option><option value='Trinidad and Tobago'>Trinidad and Tobago<\/option><option value='Tristan da Cunha'>Tristan da Cunha<\/option><option value='Tunisia'>Tunisia<\/option><option value='Turkey'>Turkey<\/option><option value='Turkmenistan'>Turkmenistan<\/option><option value='Turks and Caicos Islands'>Turks and Caicos Islands<\/option><option value='Tuvalu'>Tuvalu<\/option><option value='U.S. Virgin Islands'>U.S. Virgin Islands<\/option><option value='Uganda'>Uganda<\/option><option value='Ukraine'>Ukraine<\/option><option value='United Arab Emirates'>United Arab Emirates<\/option><option value='United Kingdom'>United Kingdom<\/option><option value='United States'>United States<\/option><option value='United States Minor Outlying Islands'>United States Minor Outlying Islands<\/option><option value='Uruguay'>Uruguay<\/option><option value='Uzbekistan'>Uzbekistan<\/option><option value='Vanuatu'>Vanuatu<\/option><option value='Vatican City'>Vatican City<\/option><option value='Venezuela'>Venezuela<\/option><option value='Vietnam'>Vietnam<\/option><option value='Wallis and Futuna'>Wallis and Futuna<\/option><option value='Western Sahara'>Western Sahara<\/option><option value='Yemen'>Yemen<\/option><option value='Zambia'>Zambia<\/option><option value='Zimbabwe'>Zimbabwe<\/option><\/select><label for='input_1_73_1' id='input_1_73_1_label' class='hidden_sub_label'>Negara<\/label><\/span><span class='ginput_right gfcws_stateload address_state ginput_address_state' id='input_1_73_2_container' ><select class='large' data-custom-input='' name='input_73.2' id='input_1_73_2' class=\"gfield_select\"   ><option name='states_input_placeholders' value='Negeri'>Negeri<\/option><option value='Johor'>Johor<\/option><option value='Kedah'>Kedah<\/option><option value='Kuala Lumpur'>Kuala Lumpur<\/option><option value='Kelantan'>Kelantan<\/option><option value='Labuan'>Labuan<\/option><option value='Malacca'>Malacca<\/option><option value='Negeri Sembilan'>Negeri Sembilan<\/option><option value='Penang'>Penang<\/option><option value='Pahang'>Pahang<\/option><option value='Perak'>Perak<\/option><option value='Perlis'>Perlis<\/option><option value='Sabah'>Sabah<\/option><option value='Selangor'>Selangor<\/option><option value='Sarawak'>Sarawak<\/option><option value='Terengganu'>Terengganu<\/option><option value='Wilayah Persekutuan'>Wilayah Persekutuan<\/option><\/select><label for='input_1_73_2' id='input_1_73_2_label' class='hidden_sub_label'>Negeri<\/label><\/span><div class='gf_clear gf_clear_complex'><\/div><\/div><\/fieldset><div id=\"field_1_27\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_27\"><label class='gfield_label gform-field-label' for='input_1_27' >Nama Sekolah Terakhir<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_27' id='input_1_27' type='text' value='' class='large'    placeholder='(Nama Sekolah Serta Alamat)' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_28\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_28\"><h3 class=\"gsection_title\">(B) MAKLUMAT WARIS\/PENJAGA<\/h3><\/div><div id=\"field_1_33\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_33\"><h3 class=\"gsection_title\">MAKLUMAT BAPA<\/h3><\/div><div id=\"field_1_29\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_29\"><label class='gfield_label gform-field-label' for='input_1_29' >Nama Bapa<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_29'>(Seperti kad pengenalan\/passport)<\/div><div class='ginput_container ginput_container_text'><input name='input_29' id='input_1_29' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_29\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_79\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_79\"><label class='gfield_label gform-field-label' for='input_1_79' >No. Kad Pengenalan \/ Passport<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_79'>(Tanpa ruang\/sengkang)<\/div><div class='ginput_container ginput_container_text'><input name='input_79' id='input_1_79' type='text' value='' class='medium'  aria-describedby=\"gfield_description_1_79\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_1_88\"  class=\"gfield gfield--type-countrywisestate gfield--input-type-countrywisestate gfield--width-full gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_88\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Warganegara<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container has_state ginput_container_address' name='country_state_fliter' id='input_1_88' >           \n            <span class='ginput_left address_country ginput_address_country' id='input_1_88_1_container' ><select class='large' data-show-subtext='true' data-live-search='true' name='input_88.1' id='input_1_88_1' class=\"gfield_select\"    ><option value=\"\">Select Country<\/option><option value='Afghanistan'>Afghanistan<\/option><option value='Aland'>Aland<\/option><option value='Albania'>Albania<\/option><option value='Algeria'>Algeria<\/option><option value='American Samoa'>American Samoa<\/option><option value='Andorra'>Andorra<\/option><option value='Angola'>Angola<\/option><option value='Anguilla'>Anguilla<\/option><option value='Antarctica'>Antarctica<\/option><option value='Antigua and Barbuda'>Antigua and Barbuda<\/option><option value='Argentina'>Argentina<\/option><option value='Armenia'>Armenia<\/option><option value='Aruba'>Aruba<\/option><option value='Ascension'>Ascension<\/option><option value='Australia'>Australia<\/option><option value='Austria'>Austria<\/option><option value='Azerbaijan'>Azerbaijan<\/option><option value='Bahamas'>Bahamas<\/option><option value='Bahrain'>Bahrain<\/option><option value='Bangladesh'>Bangladesh<\/option><option value='Barbados'>Barbados<\/option><option value='Belarus'>Belarus<\/option><option value='Belgium'>Belgium<\/option><option value='Belize'>Belize<\/option><option value='Benin'>Benin<\/option><option value='Bermuda'>Bermuda<\/option><option value='Bhutan'>Bhutan<\/option><option value='Bolivia'>Bolivia<\/option><option value='Bosnia and Herzegovina'>Bosnia and Herzegovina<\/option><option value='Botswana'>Botswana<\/option><option value='Bouvet Island'>Bouvet Island<\/option><option value='Brazil'>Brazil<\/option><option value='British Indian Ocean Territory'>British Indian Ocean Territory<\/option><option value='British Virgin Islands'>British Virgin Islands<\/option><option value='Brunei'>Brunei<\/option><option value='Bulgaria'>Bulgaria<\/option><option value='Burkina Faso'>Burkina Faso<\/option><option value='Burundi'>Burundi<\/option><option value='Cambodia'>Cambodia<\/option><option value='Cameroon'>Cameroon<\/option><option value='Canada'>Canada<\/option><option value='Cape Verde'>Cape Verde<\/option><option value='Cayman Islands'>Cayman Islands<\/option><option value='Central African Republic'>Central African Republic<\/option><option value='Chad'>Chad<\/option><option value='Chile'>Chile<\/option><option value='China'>China<\/option><option value='Christmas Island'>Christmas Island<\/option><option value='Cocos (Keeling) Islands'>Cocos (Keeling) Islands<\/option><option value='Colombia'>Colombia<\/option><option value='Comoros'>Comoros<\/option><option value='Congo'>Congo<\/option><option value='Congo (DRC)'>Congo (DRC)<\/option><option value='Cook Islands'>Cook Islands<\/option><option value='Costa Rica'>Costa Rica<\/option><option value='Cote d'Ivoire'>Cote d&#8217;Ivoire<\/option><option value='Croatia'>Croatia<\/option><option value='Cuba'>Cuba<\/option><option value='Cyprus'>Cyprus<\/option><option value='Czech Republic'>Czech Republic<\/option><option value='Denmark'>Denmark<\/option><option value='Djibouti'>Djibouti<\/option><option value='Dominica'>Dominica<\/option><option value='Dominican Republic'>Dominican Republic<\/option><option value='Ecuador'>Ecuador<\/option><option value='Egypt'>Egypt<\/option><option value='El Salvador'>El Salvador<\/option><option value='Equatorial Guinea'>Equatorial Guinea<\/option><option value='Eritrea'>Eritrea<\/option><option value='Estonia'>Estonia<\/option><option value='Ethiopia'>Ethiopia<\/option><option value='Falkland Islands (Islas Malvinas)'>Falkland Islands (Islas Malvinas)<\/option><option value='Faroe Islands'>Faroe Islands<\/option><option value='Fiji'>Fiji<\/option><option value='Finland'>Finland<\/option><option value='France'>France<\/option><option value='French Guiana'>French Guiana<\/option><option value='French Polynesia'>French Polynesia<\/option><option value='French Southern and Antarctic Lands'>French Southern and Antarctic Lands<\/option><option value='Gabon'>Gabon<\/option><option value='Gambia'>Gambia<\/option><option value='Georgia'>Georgia<\/option><option value='Germany'>Germany<\/option><option value='Ghana'>Ghana<\/option><option value='Gibraltar'>Gibraltar<\/option><option value='Greece'>Greece<\/option><option value='Greenland'>Greenland<\/option><option value='Grenada'>Grenada<\/option><option value='Guadeloupe'>Guadeloupe<\/option><option value='Guam'>Guam<\/option><option value='Guatemala'>Guatemala<\/option><option value='Guernsey'>Guernsey<\/option><option value='Guinea'>Guinea<\/option><option value='Guinea-Bissau'>Guinea-Bissau<\/option><option value='Guyana'>Guyana<\/option><option value='Haiti'>Haiti<\/option><option value='Heard Island and McDonald Islands'>Heard Island and McDonald Islands<\/option><option value='Honduras'>Honduras<\/option><option value='Hong Kong'>Hong Kong<\/option><option value='Hungary'>Hungary<\/option><option value='Iceland'>Iceland<\/option><option value='India'>India<\/option><option value='Indonesia'>Indonesia<\/option><option value='Iran'>Iran<\/option><option value='Iraq'>Iraq<\/option><option value='Ireland'>Ireland<\/option><option value='Isle of Man'>Isle of Man<\/option><option value='Israel'>Israel<\/option><option value='Italy'>Italy<\/option><option value='Jamaica'>Jamaica<\/option><option value='Japan'>Japan<\/option><option value='Jersey'>Jersey<\/option><option value='Jordan'>Jordan<\/option><option value='Kazakhstan'>Kazakhstan<\/option><option value='Kenya'>Kenya<\/option><option value='Kiribati'>Kiribati<\/option><option value='Korea (North Korea)'>Korea (North Korea)<\/option><option value='Korea (South Korea)'>Korea (South Korea)<\/option><option value='Kosovo'>Kosovo<\/option><option value='Kuwait'>Kuwait<\/option><option value='Kyrgyzstan'>Kyrgyzstan<\/option><option value='Laos'>Laos<\/option><option value='Latvia'>Latvia<\/option><option value='Lebanon'>Lebanon<\/option><option value='Lesotho'>Lesotho<\/option><option value='Liberia'>Liberia<\/option><option value='Libya'>Libya<\/option><option value='Liechtenstein'>Liechtenstein<\/option><option value='Lithuania'>Lithuania<\/option><option value='Luxembourg'>Luxembourg<\/option><option value='Macau'>Macau<\/option><option value='Macedonia'>Macedonia<\/option><option value='Madagascar'>Madagascar<\/option><option value='Malawi'>Malawi<\/option><option value='Malaysia' selected>Malaysia<\/option><option value='Maldives'>Maldives<\/option><option value='Mali'>Mali<\/option><option value='Malta'>Malta<\/option><option value='Marshall Islands'>Marshall Islands<\/option><option value='Martinique'>Martinique<\/option><option value='Mauritania'>Mauritania<\/option><option value='Mauritius'>Mauritius<\/option><option value='Mayotte'>Mayotte<\/option><option value='Mexico'>Mexico<\/option><option value='Micronesia'>Micronesia<\/option><option value='Moldova'>Moldova<\/option><option value='Monaco'>Monaco<\/option><option value='Mongolia'>Mongolia<\/option><option value='Montenegro'>Montenegro<\/option><option value='Montserrat'>Montserrat<\/option><option value='Morocco'>Morocco<\/option><option value='Mozambique'>Mozambique<\/option><option value='Myanmar (Burma)'>Myanmar (Burma)<\/option><option value='Namibia'>Namibia<\/option><option value='Nauru'>Nauru<\/option><option value='Nepal'>Nepal<\/option><option value='Netherlands'>Netherlands<\/option><option value='Netherlands Antilles'>Netherlands Antilles<\/option><option value='New Caledonia'>New Caledonia<\/option><option value='New Zealand'>New Zealand<\/option><option value='Nicaragua'>Nicaragua<\/option><option value='Niger'>Niger<\/option><option value='Nigeria'>Nigeria<\/option><option value='Niue'>Niue<\/option><option value='Northern Mariana Islands'>Northern Mariana Islands<\/option><option value='Norway'>Norway<\/option><option value='Oman'>Oman<\/option><option value='Pakistan'>Pakistan<\/option><option value='Palau'>Palau<\/option><option value='Palestinian Territories (Gaza Strip and West Bank)'>Palestinian Territories (Gaza Strip and West Bank)<\/option><option value='Panama'>Panama<\/option><option value='Papua New Guinea'>Papua New Guinea<\/option><option value='Paraguay'>Paraguay<\/option><option value='Peru'>Peru<\/option><option value='Philippines'>Philippines<\/option><option value='Pitcairn Islands'>Pitcairn Islands<\/option><option value='Poland'>Poland<\/option><option value='Portugal'>Portugal<\/option><option value='Puerto Rico'>Puerto Rico<\/option><option value='Qatar'>Qatar<\/option><option value='Reunion'>Reunion<\/option><option value='Romania'>Romania<\/option><option value='Russia'>Russia<\/option><option value='Rwanda'>Rwanda<\/option><option value='Saint Helena'>Saint Helena<\/option><option value='Saint Kitts and Nevis'>Saint Kitts and Nevis<\/option><option value='Saint Lucia'>Saint Lucia<\/option><option value='Saint Pierre and Miquelon'>Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines'>Saint Vincent and the Grenadines<\/option><option value='Samoa'>Samoa<\/option><option value='San Marino'>San Marino<\/option><option value='Sao Tome and Principe'>Sao Tome and Principe<\/option><option value='Saudi Arabia'>Saudi Arabia<\/option><option value='Senegal'>Senegal<\/option><option value='Serbia'>Serbia<\/option><option value='Seychelles'>Seychelles<\/option><option value='Sierra Leone'>Sierra Leone<\/option><option value='Singapore'>Singapore<\/option><option value='Slovakia'>Slovakia<\/option><option value='Slovenia'>Slovenia<\/option><option value='Solomon Islands'>Solomon Islands<\/option><option value='Somalia'>Somalia<\/option><option value='South Africa'>South Africa<\/option><option value='South Georgia and the South Sandwich Islands'>South Georgia and the South Sandwich Islands<\/option><option value='Spain'>Spain<\/option><option value='Sri Lanka'>Sri Lanka<\/option><option value='Sudan'>Sudan<\/option><option value='Suriname'>Suriname<\/option><option value='Svalbard'>Svalbard<\/option><option value='Swaziland'>Swaziland<\/option><option value='Sweden'>Sweden<\/option><option value='Switzerland'>Switzerland<\/option><option value='Syria'>Syria<\/option><option value='Taiwan'>Taiwan<\/option><option value='Tajikistan'>Tajikistan<\/option><option value='Tanzania'>Tanzania<\/option><option value='Thailand'>Thailand<\/option><option value='Timor-Leste (East Timor)'>Timor-Leste (East Timor)<\/option><option value='Togo'>Togo<\/option><option value='Tokelau'>Tokelau<\/option><option value='Tonga'>Tonga<\/option><option value='Trinidad and Tobago'>Trinidad and Tobago<\/option><option value='Tristan da Cunha'>Tristan da Cunha<\/option><option value='Tunisia'>Tunisia<\/option><option value='Turkey'>Turkey<\/option><option value='Turkmenistan'>Turkmenistan<\/option><option value='Turks and Caicos Islands'>Turks and Caicos Islands<\/option><option value='Tuvalu'>Tuvalu<\/option><option value='U.S. Virgin Islands'>U.S. Virgin Islands<\/option><option value='Uganda'>Uganda<\/option><option value='Ukraine'>Ukraine<\/option><option value='United Arab Emirates'>United Arab Emirates<\/option><option value='United Kingdom'>United Kingdom<\/option><option value='United States'>United States<\/option><option value='United States Minor Outlying Islands'>United States Minor Outlying Islands<\/option><option value='Uruguay'>Uruguay<\/option><option value='Uzbekistan'>Uzbekistan<\/option><option value='Vanuatu'>Vanuatu<\/option><option value='Vatican City'>Vatican City<\/option><option value='Venezuela'>Venezuela<\/option><option value='Vietnam'>Vietnam<\/option><option value='Wallis and Futuna'>Wallis and Futuna<\/option><option value='Western Sahara'>Western Sahara<\/option><option value='Yemen'>Yemen<\/option><option value='Zambia'>Zambia<\/option><option value='Zimbabwe'>Zimbabwe<\/option><\/select><label for='input_1_88_1' id='input_1_88_1_label' class='hidden_sub_label'>Country<\/label><\/span><input type='hidden' class='gform_hidden' name='input_88.2' id='input_1_88_2' value='Malaysia'\/><div class='gf_clear gf_clear_complex'><\/div><\/div><\/fieldset><div id=\"field_1_104\"  class=\"gfield gfield--type-select gfield--width-full field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_104\"><label class='gfield_label gform-field-label' for='input_1_104' >Status<\/label><div class='ginput_container ginput_container_select'><select name='input_104' id='input_1_104' class='medium gfield_select'     aria-invalid=\"false\" ><option value='Masih Hidup' >Masih Hidup<\/option><option value='Meninggal Dunia' >Meninggal Dunia<\/option><option value='Kurang Upaya' >Kurang Upaya<\/option><option value='Bersara' >Bersara<\/option><\/select><\/div><\/div><div id=\"field_1_81\"  class=\"gfield gfield--type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_81\"><label class='gfield_label gform-field-label' for='input_1_81' >No. Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_81'>(No. phone mudah hubungi)<\/div><div class='ginput_container ginput_container_phone'><input name='input_81' id='input_1_81' type='text' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_1_81\"  \/><\/div><\/div><div id=\"field_1_50\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_50\"><label class='gfield_label gform-field-label' for='input_1_50' >Pekerjaan<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_50' id='input_1_50' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_40\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_40\"><label class='gfield_label gform-field-label' for='input_1_40' >Majikan<\/label><div class='gfield_description' id='gfield_description_1_40'>(Nama Majikan Serta alamat)<\/div><div class='ginput_container ginput_container_text'><input name='input_40' id='input_1_40' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_40\"    aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_39\"  class=\"gfield gfield--type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_39\"><label class='gfield_label gform-field-label' for='input_1_39' >Pendapatan Bulanan<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_39' id='input_1_39' type='text'    value='' class='medium'    placeholder='RM' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_1_41\"  class=\"gfield gfield--type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_41\"><label class='gfield_label gform-field-label' for='input_1_41' >Bilangan Anak \/ Tanggungan<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_41' id='input_1_41' type='text'    value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_1_42\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_42\"><h3 class=\"gsection_title\">MAKLUMAT IBU<\/h3><\/div><div id=\"field_1_43\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_43\"><label class='gfield_label gform-field-label' for='input_1_43' >Nama Ibu<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_43'>(Seperti kad pengenalan\/passport)<\/div><div class='ginput_container ginput_container_text'><input name='input_43' id='input_1_43' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_43\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_82\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_82\"><label class='gfield_label gform-field-label' for='input_1_82' >No. Kad Pengenalan \/ Passport<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_82'>(Tanpa ruang\/sengkang)<\/div><div class='ginput_container ginput_container_text'><input name='input_82' id='input_1_82' type='text' value='' class='medium'  aria-describedby=\"gfield_description_1_82\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_1_89\"  class=\"gfield gfield--type-countrywisestate gfield--input-type-countrywisestate gfield--width-full gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_89\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Warganegara<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container has_state ginput_container_address' name='country_state_fliter' id='input_1_89' >           \n            <span class='ginput_left address_country ginput_address_country' id='input_1_89_1_container' ><select class='large' data-show-subtext='true' data-live-search='true' name='input_89.1' id='input_1_89_1' class=\"gfield_select\"    ><option value=\"\">Select Country<\/option><option value='Afghanistan'>Afghanistan<\/option><option value='Aland'>Aland<\/option><option value='Albania'>Albania<\/option><option value='Algeria'>Algeria<\/option><option value='American Samoa'>American Samoa<\/option><option value='Andorra'>Andorra<\/option><option value='Angola'>Angola<\/option><option value='Anguilla'>Anguilla<\/option><option value='Antarctica'>Antarctica<\/option><option value='Antigua and Barbuda'>Antigua and Barbuda<\/option><option value='Argentina'>Argentina<\/option><option value='Armenia'>Armenia<\/option><option value='Aruba'>Aruba<\/option><option value='Ascension'>Ascension<\/option><option value='Australia'>Australia<\/option><option value='Austria'>Austria<\/option><option value='Azerbaijan'>Azerbaijan<\/option><option value='Bahamas'>Bahamas<\/option><option value='Bahrain'>Bahrain<\/option><option value='Bangladesh'>Bangladesh<\/option><option value='Barbados'>Barbados<\/option><option value='Belarus'>Belarus<\/option><option value='Belgium'>Belgium<\/option><option value='Belize'>Belize<\/option><option value='Benin'>Benin<\/option><option value='Bermuda'>Bermuda<\/option><option value='Bhutan'>Bhutan<\/option><option value='Bolivia'>Bolivia<\/option><option value='Bosnia and Herzegovina'>Bosnia and Herzegovina<\/option><option value='Botswana'>Botswana<\/option><option value='Bouvet Island'>Bouvet Island<\/option><option value='Brazil'>Brazil<\/option><option value='British Indian Ocean Territory'>British Indian Ocean Territory<\/option><option value='British Virgin Islands'>British Virgin Islands<\/option><option value='Brunei'>Brunei<\/option><option value='Bulgaria'>Bulgaria<\/option><option value='Burkina Faso'>Burkina Faso<\/option><option value='Burundi'>Burundi<\/option><option value='Cambodia'>Cambodia<\/option><option value='Cameroon'>Cameroon<\/option><option value='Canada'>Canada<\/option><option value='Cape Verde'>Cape Verde<\/option><option value='Cayman Islands'>Cayman Islands<\/option><option value='Central African Republic'>Central African Republic<\/option><option value='Chad'>Chad<\/option><option value='Chile'>Chile<\/option><option value='China'>China<\/option><option value='Christmas Island'>Christmas Island<\/option><option value='Cocos (Keeling) Islands'>Cocos (Keeling) Islands<\/option><option value='Colombia'>Colombia<\/option><option value='Comoros'>Comoros<\/option><option value='Congo'>Congo<\/option><option value='Congo (DRC)'>Congo (DRC)<\/option><option value='Cook Islands'>Cook Islands<\/option><option value='Costa Rica'>Costa Rica<\/option><option value='Cote d'Ivoire'>Cote d&#8217;Ivoire<\/option><option value='Croatia'>Croatia<\/option><option value='Cuba'>Cuba<\/option><option value='Cyprus'>Cyprus<\/option><option value='Czech Republic'>Czech Republic<\/option><option value='Denmark'>Denmark<\/option><option value='Djibouti'>Djibouti<\/option><option value='Dominica'>Dominica<\/option><option value='Dominican Republic'>Dominican Republic<\/option><option value='Ecuador'>Ecuador<\/option><option value='Egypt'>Egypt<\/option><option value='El Salvador'>El Salvador<\/option><option value='Equatorial Guinea'>Equatorial Guinea<\/option><option value='Eritrea'>Eritrea<\/option><option value='Estonia'>Estonia<\/option><option value='Ethiopia'>Ethiopia<\/option><option value='Falkland Islands (Islas Malvinas)'>Falkland Islands (Islas Malvinas)<\/option><option value='Faroe Islands'>Faroe Islands<\/option><option value='Fiji'>Fiji<\/option><option value='Finland'>Finland<\/option><option value='France'>France<\/option><option value='French Guiana'>French Guiana<\/option><option value='French Polynesia'>French Polynesia<\/option><option value='French Southern and Antarctic Lands'>French Southern and Antarctic Lands<\/option><option value='Gabon'>Gabon<\/option><option value='Gambia'>Gambia<\/option><option value='Georgia'>Georgia<\/option><option value='Germany'>Germany<\/option><option value='Ghana'>Ghana<\/option><option value='Gibraltar'>Gibraltar<\/option><option value='Greece'>Greece<\/option><option value='Greenland'>Greenland<\/option><option value='Grenada'>Grenada<\/option><option value='Guadeloupe'>Guadeloupe<\/option><option value='Guam'>Guam<\/option><option value='Guatemala'>Guatemala<\/option><option value='Guernsey'>Guernsey<\/option><option value='Guinea'>Guinea<\/option><option value='Guinea-Bissau'>Guinea-Bissau<\/option><option value='Guyana'>Guyana<\/option><option value='Haiti'>Haiti<\/option><option value='Heard Island and McDonald Islands'>Heard Island and McDonald Islands<\/option><option value='Honduras'>Honduras<\/option><option value='Hong Kong'>Hong Kong<\/option><option value='Hungary'>Hungary<\/option><option value='Iceland'>Iceland<\/option><option value='India'>India<\/option><option value='Indonesia'>Indonesia<\/option><option value='Iran'>Iran<\/option><option value='Iraq'>Iraq<\/option><option value='Ireland'>Ireland<\/option><option value='Isle of Man'>Isle of Man<\/option><option value='Israel'>Israel<\/option><option value='Italy'>Italy<\/option><option value='Jamaica'>Jamaica<\/option><option value='Japan'>Japan<\/option><option value='Jersey'>Jersey<\/option><option value='Jordan'>Jordan<\/option><option value='Kazakhstan'>Kazakhstan<\/option><option value='Kenya'>Kenya<\/option><option value='Kiribati'>Kiribati<\/option><option value='Korea (North Korea)'>Korea (North Korea)<\/option><option value='Korea (South Korea)'>Korea (South Korea)<\/option><option value='Kosovo'>Kosovo<\/option><option value='Kuwait'>Kuwait<\/option><option value='Kyrgyzstan'>Kyrgyzstan<\/option><option value='Laos'>Laos<\/option><option value='Latvia'>Latvia<\/option><option value='Lebanon'>Lebanon<\/option><option value='Lesotho'>Lesotho<\/option><option value='Liberia'>Liberia<\/option><option value='Libya'>Libya<\/option><option value='Liechtenstein'>Liechtenstein<\/option><option value='Lithuania'>Lithuania<\/option><option value='Luxembourg'>Luxembourg<\/option><option value='Macau'>Macau<\/option><option value='Macedonia'>Macedonia<\/option><option value='Madagascar'>Madagascar<\/option><option value='Malawi'>Malawi<\/option><option value='Malaysia' selected>Malaysia<\/option><option value='Maldives'>Maldives<\/option><option value='Mali'>Mali<\/option><option value='Malta'>Malta<\/option><option value='Marshall Islands'>Marshall Islands<\/option><option value='Martinique'>Martinique<\/option><option value='Mauritania'>Mauritania<\/option><option value='Mauritius'>Mauritius<\/option><option value='Mayotte'>Mayotte<\/option><option value='Mexico'>Mexico<\/option><option value='Micronesia'>Micronesia<\/option><option value='Moldova'>Moldova<\/option><option value='Monaco'>Monaco<\/option><option value='Mongolia'>Mongolia<\/option><option value='Montenegro'>Montenegro<\/option><option value='Montserrat'>Montserrat<\/option><option value='Morocco'>Morocco<\/option><option value='Mozambique'>Mozambique<\/option><option value='Myanmar (Burma)'>Myanmar (Burma)<\/option><option value='Namibia'>Namibia<\/option><option value='Nauru'>Nauru<\/option><option value='Nepal'>Nepal<\/option><option value='Netherlands'>Netherlands<\/option><option value='Netherlands Antilles'>Netherlands Antilles<\/option><option value='New Caledonia'>New Caledonia<\/option><option value='New Zealand'>New Zealand<\/option><option value='Nicaragua'>Nicaragua<\/option><option value='Niger'>Niger<\/option><option value='Nigeria'>Nigeria<\/option><option value='Niue'>Niue<\/option><option value='Northern Mariana Islands'>Northern Mariana Islands<\/option><option value='Norway'>Norway<\/option><option value='Oman'>Oman<\/option><option value='Pakistan'>Pakistan<\/option><option value='Palau'>Palau<\/option><option value='Palestinian Territories (Gaza Strip and West Bank)'>Palestinian Territories (Gaza Strip and West Bank)<\/option><option value='Panama'>Panama<\/option><option value='Papua New Guinea'>Papua New Guinea<\/option><option value='Paraguay'>Paraguay<\/option><option value='Peru'>Peru<\/option><option value='Philippines'>Philippines<\/option><option value='Pitcairn Islands'>Pitcairn Islands<\/option><option value='Poland'>Poland<\/option><option value='Portugal'>Portugal<\/option><option value='Puerto Rico'>Puerto Rico<\/option><option value='Qatar'>Qatar<\/option><option value='Reunion'>Reunion<\/option><option value='Romania'>Romania<\/option><option value='Russia'>Russia<\/option><option value='Rwanda'>Rwanda<\/option><option value='Saint Helena'>Saint Helena<\/option><option value='Saint Kitts and Nevis'>Saint Kitts and Nevis<\/option><option value='Saint Lucia'>Saint Lucia<\/option><option value='Saint Pierre and Miquelon'>Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines'>Saint Vincent and the Grenadines<\/option><option value='Samoa'>Samoa<\/option><option value='San Marino'>San Marino<\/option><option value='Sao Tome and Principe'>Sao Tome and Principe<\/option><option value='Saudi Arabia'>Saudi Arabia<\/option><option value='Senegal'>Senegal<\/option><option value='Serbia'>Serbia<\/option><option value='Seychelles'>Seychelles<\/option><option value='Sierra Leone'>Sierra Leone<\/option><option value='Singapore'>Singapore<\/option><option value='Slovakia'>Slovakia<\/option><option value='Slovenia'>Slovenia<\/option><option value='Solomon Islands'>Solomon Islands<\/option><option value='Somalia'>Somalia<\/option><option value='South Africa'>South Africa<\/option><option value='South Georgia and the South Sandwich Islands'>South Georgia and the South Sandwich Islands<\/option><option value='Spain'>Spain<\/option><option value='Sri Lanka'>Sri Lanka<\/option><option value='Sudan'>Sudan<\/option><option value='Suriname'>Suriname<\/option><option value='Svalbard'>Svalbard<\/option><option value='Swaziland'>Swaziland<\/option><option value='Sweden'>Sweden<\/option><option value='Switzerland'>Switzerland<\/option><option value='Syria'>Syria<\/option><option value='Taiwan'>Taiwan<\/option><option value='Tajikistan'>Tajikistan<\/option><option value='Tanzania'>Tanzania<\/option><option value='Thailand'>Thailand<\/option><option value='Timor-Leste (East Timor)'>Timor-Leste (East Timor)<\/option><option value='Togo'>Togo<\/option><option value='Tokelau'>Tokelau<\/option><option value='Tonga'>Tonga<\/option><option value='Trinidad and Tobago'>Trinidad and Tobago<\/option><option value='Tristan da Cunha'>Tristan da Cunha<\/option><option value='Tunisia'>Tunisia<\/option><option value='Turkey'>Turkey<\/option><option value='Turkmenistan'>Turkmenistan<\/option><option value='Turks and Caicos Islands'>Turks and Caicos Islands<\/option><option value='Tuvalu'>Tuvalu<\/option><option value='U.S. Virgin Islands'>U.S. Virgin Islands<\/option><option value='Uganda'>Uganda<\/option><option value='Ukraine'>Ukraine<\/option><option value='United Arab Emirates'>United Arab Emirates<\/option><option value='United Kingdom'>United Kingdom<\/option><option value='United States'>United States<\/option><option value='United States Minor Outlying Islands'>United States Minor Outlying Islands<\/option><option value='Uruguay'>Uruguay<\/option><option value='Uzbekistan'>Uzbekistan<\/option><option value='Vanuatu'>Vanuatu<\/option><option value='Vatican City'>Vatican City<\/option><option value='Venezuela'>Venezuela<\/option><option value='Vietnam'>Vietnam<\/option><option value='Wallis and Futuna'>Wallis and Futuna<\/option><option value='Western Sahara'>Western Sahara<\/option><option value='Yemen'>Yemen<\/option><option value='Zambia'>Zambia<\/option><option value='Zimbabwe'>Zimbabwe<\/option><\/select><label for='input_1_89_1' id='input_1_89_1_label' class='hidden_sub_label'>Country<\/label><\/span><input type='hidden' class='gform_hidden' name='input_89.2' id='input_1_89_2' value='Malaysia'\/><div class='gf_clear gf_clear_complex'><\/div><\/div><\/fieldset><div id=\"field_1_105\"  class=\"gfield gfield--type-select gfield--width-full field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_105\"><label class='gfield_label gform-field-label' for='input_1_105' >Status<\/label><div class='ginput_container ginput_container_select'><select name='input_105' id='input_1_105' class='medium gfield_select'     aria-invalid=\"false\" ><option value='Masih Hidup' >Masih Hidup<\/option><option value='Meninggal Dunia' >Meninggal Dunia<\/option><option value='Kurang Upaya' >Kurang Upaya<\/option><option value='Bersara' >Bersara<\/option><\/select><\/div><\/div><div id=\"field_1_83\"  class=\"gfield gfield--type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_83\"><label class='gfield_label gform-field-label' for='input_1_83' >No. Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_83'>(No. phone mudah hubungi)<\/div><div class='ginput_container ginput_container_phone'><input name='input_83' id='input_1_83' type='text' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_1_83\"  \/><\/div><\/div><div id=\"field_1_47\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_47\"><label class='gfield_label gform-field-label' for='input_1_47' >Pekerjaan<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_47' id='input_1_47' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_52\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_52\"><label class='gfield_label gform-field-label' for='input_1_52' >Majikan<\/label><div class='gfield_description' id='gfield_description_1_52'>(Nama Majikan Serta alamat)<\/div><div class='ginput_container ginput_container_text'><input name='input_52' id='input_1_52' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_52\"    aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_51\"  class=\"gfield gfield--type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_51\"><label class='gfield_label gform-field-label' for='input_1_51' >Pendapatan Bulanan<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_51' id='input_1_51' type='text'    value='' class='medium'    placeholder='RM' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_1_55\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_55\"><h3 class=\"gsection_title\">MAKLUMAT PENJAGA<\/h3><div class='gsection_description' id='gfield_description_1_55'>(Maklumat Waris Penjaga, Ibu atau Bapa)<\/div><\/div><div id=\"field_1_56\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_56\"><label class='gfield_label gform-field-label' for='input_1_56' >Nama Penjaga<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_56'>(Seperti kad pengenalan\/passport)<\/div><div class='ginput_container ginput_container_text'><input name='input_56' id='input_1_56' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_56\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_84\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_84\"><label class='gfield_label gform-field-label' for='input_1_84' >No. Kad Pengenalan \/ Passport<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_84'>(Tanpa ruang\/sengkang)<\/div><div class='ginput_container ginput_container_text'><input name='input_84' id='input_1_84' type='text' value='' class='medium'  aria-describedby=\"gfield_description_1_84\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_1_90\"  class=\"gfield gfield--type-countrywisestate gfield--input-type-countrywisestate gfield--width-full gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_90\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Warganegara<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container has_state ginput_container_address' name='country_state_fliter' id='input_1_90' >           \n            <span class='ginput_left address_country ginput_address_country' id='input_1_90_1_container' ><select class='large' data-show-subtext='true' data-live-search='true' name='input_90.1' id='input_1_90_1' class=\"gfield_select\"    ><option value=\"\">Select Country<\/option><option value='Afghanistan'>Afghanistan<\/option><option value='Aland'>Aland<\/option><option value='Albania'>Albania<\/option><option value='Algeria'>Algeria<\/option><option value='American Samoa'>American Samoa<\/option><option value='Andorra'>Andorra<\/option><option value='Angola'>Angola<\/option><option value='Anguilla'>Anguilla<\/option><option value='Antarctica'>Antarctica<\/option><option value='Antigua and Barbuda'>Antigua and Barbuda<\/option><option value='Argentina'>Argentina<\/option><option value='Armenia'>Armenia<\/option><option value='Aruba'>Aruba<\/option><option value='Ascension'>Ascension<\/option><option value='Australia'>Australia<\/option><option value='Austria'>Austria<\/option><option value='Azerbaijan'>Azerbaijan<\/option><option value='Bahamas'>Bahamas<\/option><option value='Bahrain'>Bahrain<\/option><option value='Bangladesh'>Bangladesh<\/option><option value='Barbados'>Barbados<\/option><option value='Belarus'>Belarus<\/option><option value='Belgium'>Belgium<\/option><option value='Belize'>Belize<\/option><option value='Benin'>Benin<\/option><option value='Bermuda'>Bermuda<\/option><option value='Bhutan'>Bhutan<\/option><option value='Bolivia'>Bolivia<\/option><option value='Bosnia and Herzegovina'>Bosnia and Herzegovina<\/option><option value='Botswana'>Botswana<\/option><option value='Bouvet Island'>Bouvet Island<\/option><option value='Brazil'>Brazil<\/option><option value='British Indian Ocean Territory'>British Indian Ocean Territory<\/option><option value='British Virgin Islands'>British Virgin Islands<\/option><option value='Brunei'>Brunei<\/option><option value='Bulgaria'>Bulgaria<\/option><option value='Burkina Faso'>Burkina Faso<\/option><option value='Burundi'>Burundi<\/option><option value='Cambodia'>Cambodia<\/option><option value='Cameroon'>Cameroon<\/option><option value='Canada'>Canada<\/option><option value='Cape Verde'>Cape Verde<\/option><option value='Cayman Islands'>Cayman Islands<\/option><option value='Central African Republic'>Central African Republic<\/option><option value='Chad'>Chad<\/option><option value='Chile'>Chile<\/option><option value='China'>China<\/option><option value='Christmas Island'>Christmas Island<\/option><option value='Cocos (Keeling) Islands'>Cocos (Keeling) Islands<\/option><option value='Colombia'>Colombia<\/option><option value='Comoros'>Comoros<\/option><option value='Congo'>Congo<\/option><option value='Congo (DRC)'>Congo (DRC)<\/option><option value='Cook Islands'>Cook Islands<\/option><option value='Costa Rica'>Costa Rica<\/option><option value='Cote d'Ivoire'>Cote d&#8217;Ivoire<\/option><option value='Croatia'>Croatia<\/option><option value='Cuba'>Cuba<\/option><option value='Cyprus'>Cyprus<\/option><option value='Czech Republic'>Czech Republic<\/option><option value='Denmark'>Denmark<\/option><option value='Djibouti'>Djibouti<\/option><option value='Dominica'>Dominica<\/option><option value='Dominican Republic'>Dominican Republic<\/option><option value='Ecuador'>Ecuador<\/option><option value='Egypt'>Egypt<\/option><option value='El Salvador'>El Salvador<\/option><option value='Equatorial Guinea'>Equatorial Guinea<\/option><option value='Eritrea'>Eritrea<\/option><option value='Estonia'>Estonia<\/option><option value='Ethiopia'>Ethiopia<\/option><option value='Falkland Islands (Islas Malvinas)'>Falkland Islands (Islas Malvinas)<\/option><option value='Faroe Islands'>Faroe Islands<\/option><option value='Fiji'>Fiji<\/option><option value='Finland'>Finland<\/option><option value='France'>France<\/option><option value='French Guiana'>French Guiana<\/option><option value='French Polynesia'>French Polynesia<\/option><option value='French Southern and Antarctic Lands'>French Southern and Antarctic Lands<\/option><option value='Gabon'>Gabon<\/option><option value='Gambia'>Gambia<\/option><option value='Georgia'>Georgia<\/option><option value='Germany'>Germany<\/option><option value='Ghana'>Ghana<\/option><option value='Gibraltar'>Gibraltar<\/option><option value='Greece'>Greece<\/option><option value='Greenland'>Greenland<\/option><option value='Grenada'>Grenada<\/option><option value='Guadeloupe'>Guadeloupe<\/option><option value='Guam'>Guam<\/option><option value='Guatemala'>Guatemala<\/option><option value='Guernsey'>Guernsey<\/option><option value='Guinea'>Guinea<\/option><option value='Guinea-Bissau'>Guinea-Bissau<\/option><option value='Guyana'>Guyana<\/option><option value='Haiti'>Haiti<\/option><option value='Heard Island and McDonald Islands'>Heard Island and McDonald Islands<\/option><option value='Honduras'>Honduras<\/option><option value='Hong Kong'>Hong Kong<\/option><option value='Hungary'>Hungary<\/option><option value='Iceland'>Iceland<\/option><option value='India'>India<\/option><option value='Indonesia'>Indonesia<\/option><option value='Iran'>Iran<\/option><option value='Iraq'>Iraq<\/option><option value='Ireland'>Ireland<\/option><option value='Isle of Man'>Isle of Man<\/option><option value='Israel'>Israel<\/option><option value='Italy'>Italy<\/option><option value='Jamaica'>Jamaica<\/option><option value='Japan'>Japan<\/option><option value='Jersey'>Jersey<\/option><option value='Jordan'>Jordan<\/option><option value='Kazakhstan'>Kazakhstan<\/option><option value='Kenya'>Kenya<\/option><option value='Kiribati'>Kiribati<\/option><option value='Korea (North Korea)'>Korea (North Korea)<\/option><option value='Korea (South Korea)'>Korea (South Korea)<\/option><option value='Kosovo'>Kosovo<\/option><option value='Kuwait'>Kuwait<\/option><option value='Kyrgyzstan'>Kyrgyzstan<\/option><option value='Laos'>Laos<\/option><option value='Latvia'>Latvia<\/option><option value='Lebanon'>Lebanon<\/option><option value='Lesotho'>Lesotho<\/option><option value='Liberia'>Liberia<\/option><option value='Libya'>Libya<\/option><option value='Liechtenstein'>Liechtenstein<\/option><option value='Lithuania'>Lithuania<\/option><option value='Luxembourg'>Luxembourg<\/option><option value='Macau'>Macau<\/option><option value='Macedonia'>Macedonia<\/option><option value='Madagascar'>Madagascar<\/option><option value='Malawi'>Malawi<\/option><option value='Malaysia' selected>Malaysia<\/option><option value='Maldives'>Maldives<\/option><option value='Mali'>Mali<\/option><option value='Malta'>Malta<\/option><option value='Marshall Islands'>Marshall Islands<\/option><option value='Martinique'>Martinique<\/option><option value='Mauritania'>Mauritania<\/option><option value='Mauritius'>Mauritius<\/option><option value='Mayotte'>Mayotte<\/option><option value='Mexico'>Mexico<\/option><option value='Micronesia'>Micronesia<\/option><option value='Moldova'>Moldova<\/option><option value='Monaco'>Monaco<\/option><option value='Mongolia'>Mongolia<\/option><option value='Montenegro'>Montenegro<\/option><option value='Montserrat'>Montserrat<\/option><option value='Morocco'>Morocco<\/option><option value='Mozambique'>Mozambique<\/option><option value='Myanmar (Burma)'>Myanmar (Burma)<\/option><option value='Namibia'>Namibia<\/option><option value='Nauru'>Nauru<\/option><option value='Nepal'>Nepal<\/option><option value='Netherlands'>Netherlands<\/option><option value='Netherlands Antilles'>Netherlands Antilles<\/option><option value='New Caledonia'>New Caledonia<\/option><option value='New Zealand'>New Zealand<\/option><option value='Nicaragua'>Nicaragua<\/option><option value='Niger'>Niger<\/option><option value='Nigeria'>Nigeria<\/option><option value='Niue'>Niue<\/option><option value='Northern Mariana Islands'>Northern Mariana Islands<\/option><option value='Norway'>Norway<\/option><option value='Oman'>Oman<\/option><option value='Pakistan'>Pakistan<\/option><option value='Palau'>Palau<\/option><option value='Palestinian Territories (Gaza Strip and West Bank)'>Palestinian Territories (Gaza Strip and West Bank)<\/option><option value='Panama'>Panama<\/option><option value='Papua New Guinea'>Papua New Guinea<\/option><option value='Paraguay'>Paraguay<\/option><option value='Peru'>Peru<\/option><option value='Philippines'>Philippines<\/option><option value='Pitcairn Islands'>Pitcairn Islands<\/option><option value='Poland'>Poland<\/option><option value='Portugal'>Portugal<\/option><option value='Puerto Rico'>Puerto Rico<\/option><option value='Qatar'>Qatar<\/option><option value='Reunion'>Reunion<\/option><option value='Romania'>Romania<\/option><option value='Russia'>Russia<\/option><option value='Rwanda'>Rwanda<\/option><option value='Saint Helena'>Saint Helena<\/option><option value='Saint Kitts and Nevis'>Saint Kitts and Nevis<\/option><option value='Saint Lucia'>Saint Lucia<\/option><option value='Saint Pierre and Miquelon'>Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines'>Saint Vincent and the Grenadines<\/option><option value='Samoa'>Samoa<\/option><option value='San Marino'>San Marino<\/option><option value='Sao Tome and Principe'>Sao Tome and Principe<\/option><option value='Saudi Arabia'>Saudi Arabia<\/option><option value='Senegal'>Senegal<\/option><option value='Serbia'>Serbia<\/option><option value='Seychelles'>Seychelles<\/option><option value='Sierra Leone'>Sierra Leone<\/option><option value='Singapore'>Singapore<\/option><option value='Slovakia'>Slovakia<\/option><option value='Slovenia'>Slovenia<\/option><option value='Solomon Islands'>Solomon Islands<\/option><option value='Somalia'>Somalia<\/option><option value='South Africa'>South Africa<\/option><option value='South Georgia and the South Sandwich Islands'>South Georgia and the South Sandwich Islands<\/option><option value='Spain'>Spain<\/option><option value='Sri Lanka'>Sri Lanka<\/option><option value='Sudan'>Sudan<\/option><option value='Suriname'>Suriname<\/option><option value='Svalbard'>Svalbard<\/option><option value='Swaziland'>Swaziland<\/option><option value='Sweden'>Sweden<\/option><option value='Switzerland'>Switzerland<\/option><option value='Syria'>Syria<\/option><option value='Taiwan'>Taiwan<\/option><option value='Tajikistan'>Tajikistan<\/option><option value='Tanzania'>Tanzania<\/option><option value='Thailand'>Thailand<\/option><option value='Timor-Leste (East Timor)'>Timor-Leste (East Timor)<\/option><option value='Togo'>Togo<\/option><option value='Tokelau'>Tokelau<\/option><option value='Tonga'>Tonga<\/option><option value='Trinidad and Tobago'>Trinidad and Tobago<\/option><option value='Tristan da Cunha'>Tristan da Cunha<\/option><option value='Tunisia'>Tunisia<\/option><option value='Turkey'>Turkey<\/option><option value='Turkmenistan'>Turkmenistan<\/option><option value='Turks and Caicos Islands'>Turks and Caicos Islands<\/option><option value='Tuvalu'>Tuvalu<\/option><option value='U.S. Virgin Islands'>U.S. Virgin Islands<\/option><option value='Uganda'>Uganda<\/option><option value='Ukraine'>Ukraine<\/option><option value='United Arab Emirates'>United Arab Emirates<\/option><option value='United Kingdom'>United Kingdom<\/option><option value='United States'>United States<\/option><option value='United States Minor Outlying Islands'>United States Minor Outlying Islands<\/option><option value='Uruguay'>Uruguay<\/option><option value='Uzbekistan'>Uzbekistan<\/option><option value='Vanuatu'>Vanuatu<\/option><option value='Vatican City'>Vatican City<\/option><option value='Venezuela'>Venezuela<\/option><option value='Vietnam'>Vietnam<\/option><option value='Wallis and Futuna'>Wallis and Futuna<\/option><option value='Western Sahara'>Western Sahara<\/option><option value='Yemen'>Yemen<\/option><option value='Zambia'>Zambia<\/option><option value='Zimbabwe'>Zimbabwe<\/option><\/select><label for='input_1_90_1' id='input_1_90_1_label' class='hidden_sub_label'>Country<\/label><\/span><input type='hidden' class='gform_hidden' name='input_90.2' id='input_1_90_2' value='Malaysia'\/><div class='gf_clear gf_clear_complex'><\/div><\/div><\/fieldset><div id=\"field_1_85\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_85\"><label class='gfield_label gform-field-label' for='input_1_85' >No. Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_85'>(No. phone mudah hubungi)<\/div><div class='ginput_container ginput_container_text'><input name='input_85' id='input_1_85' type='text' value='' class='medium'  aria-describedby=\"gfield_description_1_85\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_60\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_60\"><label class='gfield_label gform-field-label' for='input_1_60' >Pekerjaan<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_60' id='input_1_60' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_61\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_61\"><label class='gfield_label gform-field-label' for='input_1_61' >Majikan<\/label><div class='gfield_description' id='gfield_description_1_61'>(Nama Majikan Serta alamat)<\/div><div class='ginput_container ginput_container_text'><input name='input_61' id='input_1_61' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_61\"    aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_63\"  class=\"gfield gfield--type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_63\"><label class='gfield_label gform-field-label' for='input_1_63' >Penapatan Bulanan<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_63' id='input_1_63' type='text'    value='' class='medium'    placeholder='RM' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_1_62\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_62\"><label class='gfield_label gform-field-label' for='input_1_62' >Hubungan Dengan Pelajar<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_62' id='input_1_62' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_67\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_67\"><h3 class=\"gsection_title\">(C) DOKUMEN SOKONGAN<\/h3><\/div><div id=\"field_1_25\"  class=\"gfield gfield--type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_25\"><label class='gfield_label gform-field-label' for='gform_browse_button_1_25' >Muat Naik Dokumen Sokongan<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_25'>Dokumen pemohon diperlukan:<br>\n1. Salinan kad pengenalan atau passport pelajar.<br>\n2. Salinan kad pengenalan \/ passport ibu bapa \/ penjaga.<br>\n3. Salinan sijil \/ surat berhenti sekolah.<\/div><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_1_25' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_1_25&quot;,&quot;container&quot;:&quot;gform_multifile_upload_1_25&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_1_25&quot;,&quot;filelist&quot;:&quot;gform_preview_1_25&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/app.nh.my\\\/form\\\/?gf_page=a73a6a7d90eaea4&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/app.nh.my\\\/form\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/app.nh.my\\\/form\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;jpg,jpeg,gif,png,pdf,&quot;}],&quot;max_file_size&quot;:&quot;10485760b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:1,&quot;field_id&quot;:25},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;10&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_1_25&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_1_25' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Muat naik dokumen disini <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_1_25' class='button gform_button_select_files' aria-describedby=\"gfield_upload_rules_1_25 gfield_description_1_25\"  >Pilih dokumen<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_1_25'>Jenis dokumen dibenarkan: jpg, jpeg, gif, png, pdf, , Max. file size: 10 MB, Max. files: 10.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_1_25'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_1_25' class='ginput_preview_list'><\/div><\/div><div id=\"field_1_94\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_94\"><h3 class=\"gsection_title\">(D) PENGAKUAN<\/h3><\/div><fieldset id=\"field_1_100\"  class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_100\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Pengakuan Ibu\/Bapa\/Penjaga<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_1_100'>Saya Ibu\/Bapa\/Penjaga kepada pemohon dengan ini membuat pengakuan seperti berikut:<br \/>\n1. Sanggup menjelaskan yuran pengajian tahunan atau lain-lain bayaran.<br \/>\n2. Menasihati anak tanggungan dibawah jagaan saya supaya patuh kepada peraturan-peraturan dan disiplin sekolah ini dari semasa ke semasa.<br \/>\n3. Saya mengesahkan maklumat yang diberikan diatas ini adalah benar dan bersetuju dengan syarat-syarat yang ditetapkan.<\/div><div class='ginput_container ginput_container_consent'><input name='input_100.1' id='input_1_100_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_1_100\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_1_100_1' >Saya Setuju<\/label><input type='hidden' name='input_100.2' value='Saya Setuju' class='gform_hidden' \/><input type='hidden' name='input_100.3' value='1' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_1_101\"  class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_101\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Pengakuan Pelajar<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_1_101'>Saya mengaku bahawa segala maklumat diatas adalah benar. Dengan ini saya mengaku bahawa:<br \/>\n1. Saya akan patuh kepada peraturan-peraturan dan disiplin sekolah dari semasa ke semasa.<br \/>\n2. Berusaha untuk belajar dengan tekun dan bersungguh-sungguh.<br \/>\n3. Menjaga imej dan nama baik sekolah ini dari semasa ke semasa.<br \/>\n4. Sanggup menerima hukuman yang akan dikenakan kepada saya (Sekiranya didapati bersalah)<br \/>\n5. Akan melibatkan diri dan memberi kerjasama dalam setiap aktiviti atau program yang dianjurkan oleh pihak pengurusan sekolah.<\/div><div class='ginput_container ginput_container_consent'><input name='input_101.1' id='input_1_101_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_1_101\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_1_101_1' >Saya Setuju<\/label><input type='hidden' name='input_101.2' value='Saya Setuju' class='gform_hidden' \/><input type='hidden' name='input_101.3' value='1' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_1_64\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_64\"><h3 class=\"gsection_title\">(E) PEMBAYARAN<\/h3><\/div><div id=\"field_1_65\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_65\"><img decoding=\"async\" src=\"https:\/\/app.nh.my\/form\/wp-content\/uploads\/2024\/02\/payment-method.png\" width=\"350px\"><br>\n<small>Anda akan dibawa ke laman ToyyibPay.com untuk memilih kaedah pembayaran pilihan anda. Selepas menyelesaikan proses pembayaran, anda akan dibawa kembali ke halaman ini.<br>\n<i>Wang yuran proses tidak boleh dikembalikan setelah permohonan dibuat.<\/i>\n<\/small><\/div><div id=\"field_1_17\"  class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield_price gfield_price_1_17 gfield_product_1_17 gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_17\"><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_1_17_1' >Yuran Proses Permohonan<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_17.1' value='Yuran Proses Permohonan' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_1_17' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<label for='ginput_base_price_1_17' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Harga:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_17.2' id='ginput_base_price_1_17' class='gform_hidden' value='&#082;&#077; 10.00' aria-label='Yuran Proses Permohonan Harga'  \/>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_17.3' value='1' class='ginput_quantity_1_17 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><\/div><\/div>\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_1' class='gform_button button gform-button--width-full' value='Hantar &amp; Bayar'  onclick='if(window[\"gf_submitting_1\"]){return false;}  window[\"gf_submitting_1\"]=true;  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_1\"]){return false;} window[\"gf_submitting_1\"]=true;  jQuery(\"#gform_1\").trigger(\"submit\",[true]); }' \/> <input type='hidden' name='gform_ajax' value='form_id=1&amp;title=1&amp;description=1&amp;tabindex=0' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='1' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_1' 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