Andra Online Registration
I would like to register my kid to Andra!
NAME *
Your answer
MY KID *
Your answer
BIRTH DATE *
MM
/
DD
/
YYYY
AGE *
Your answer
NATIONALITY *
Your answer
DETAILS OF PARENTS
MOTHER’S NAME
Your answer
IC NUMBER
Your answer
ADDRESS
Your answer
HANDPHONE
Your answer
OCCUPATION
Your answer
NATIONALITY
Your answer
FATHER’S NAME
Your answer
IC NUMBER
Your answer
ADDRESS
Your answer
HANDPHONE
Your answer
OCCUPATION
Your answer
NATIONALITY
Your answer
Please attach 2 copies of your kid’s passport photo, a copy of mykid and birth certificate.
MEDICAL RECORD
MY KID ALLERGIC TO
Your answer
PHYSICAL RECORD
Your answer
HEIGHT
Your answer
WEIGHT
Your answer
EMERGENCY CONTACT
NAME
Your answer
PHONE (HOME)
Your answer
PHONE (OFFICE)
Your answer
HANDPHONE
Your answer
ADDRESS
Your answer
SIBLINGS RECORD
e.g. Muhammad Hakim - Age 4
Your answer
Your answer
Your answer
Your answer
Your answer
My registration to Andra allowing my kid to enjoy these plans: *
Required
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