This document is issued to Malaysian Citizens and Permanent Residents of Malaysia (Thailand origin) residing in the State of Kelantan, Perlis, Kedah or Perak for more than three (3) years. The validity of this document is six (6) month from the date of issue and valid for multiple journeys. No further extension is allowed.

Condition of Application   Form Imm.92   Two (2) photographs of the applicant measuring 3.5 cm x 5.0 cm   Particulars of children below 12 years old can be included in either parent's Border Pass   Documentary evidence that applicant resides in either of the States mentioned Applicant 12 years and above   Two (2) photographs of the application measuring 3.5 cm x 5.0 cm   Identification Card (MyKad) / Army Identification Card / Police Identification Card or Temporary Certificate (JPN.KPPK 09 or 11)   Permanent Resident Identification Card (Only for Permanent Resident of Thai Origin)   Birth Certificate   Father’s Identification Card Below 12 years   Two (2) photographs of the application measuring 3.5 cm x 5.0 cm   Birth Certificate   Father’s Identification Card Fees RM10.00 only