ASSOCIATION OF MARINE INDUSTRIES OF MALAYSIA

MEMBERSHIP APPLICATION FORM
MEMBERSHIP TYPE (Tick where applicable)

ORDINARY	ASSOCIATE
Section A: Shipbuilding / Shiprepair
Section B: Marine-related Industries

COMPANY DATA (Type clearly in CAPITAL letters)

1. Section I: COMPANY CORRESPONDENCE
1.1 Company Name	___________________________________________
1.2 Registered Address	___________________________________________
1.3 Correspondence Address	___________________________________________
Telephone	___________________________________________
Facsimile	___________________________________________
Telex	___________________________________________
Website	___________________________________________
Email	___________________________________________
2. Section II: LICENSING & REGISTRATION
2.1 Year of Incorporation	___________________________________________
2.2 Company Registration No.	___________________________________________
2.3 Kementerian Kewangan (Treasury) Registration No.	___________________________________________
2.4 Ministry of Trade & Industry Registration No.	___________________________________________
2.5 Manufacturing Licence No.	___________________________________________
2.6 Shipbuilding/repair Classification	___________________________________________
2.7 Others	___________________________________________
3. Section 3: PRINCIPAL ACTIVITIES __________________________________________________
4. Section 4: COMPANY REPRESENTATION
4.1 Chief Executive Officer	___________________________________________
4.2 Designation	___________________________________________
4.3 Principal Representative to AMIM Designation Telephone no./extension	___________________________________________ ___________________________________________ ___________________________________________
4.4 Alternate Representative to AMIM Designation Telephone no./extension	___________________________________________ ___________________________________________ ___________________________________________
5. Section 5: HUMAN RESOURCES
5.1 Management	M’sian:________	Foreign:________
5.2 Staff M’sian: Foreign:	M’sian:________	Foreign:________
5.3 Permanent Labour	M’sian:________	Foreign:________
5.4 Contract Labour	M’sian:________	Foreign:________
6. Section 6: FINANCIALS
6.1 Authorised Capital	RM________________
6.2 Shareholders’ Fund	RM________________
6.3 Bumiputera Equity	% ________________
6.4 Non-Bumiputera (M’sian) Equity	% ________________
6.5 Government Equity	% ________________
6.6 Foreign Equity	% ________________
7 Section 7 : Quality Performance Awards
Year 1._____________ 2._____________ 3._____________ 4._____________ 5._____________	Award/ Recognition _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________
8 Section 8: ATTACHMENTS CHECKLIST
8.1 ALL Applications	Certified copies of the following: Company Registration (ROC) Certificate Kementerian Kewangan Registration Ministry of Trade & Industry Registration Manufacturing Licence Other: Quality Performance Awards Copy of latest Annual Report Basic Organisational Chart of Company Activities
8.2 Section A Applications	List of Shipyard Facilities, Capabilities, Capacities List of Newbuildings completed over the last five years List of Refurbishments completed over the last five years
8.3 Section B Applications	List of Products Manufactured and/or Imported (state level of dealership) List of after-sales customer services List of Services, Facilities, etc.
8.4 Fees	Entrance Fee of RM1,000.00 (One-time fee) *And* Ordinary Member’s Subscription of RM1,000.00 for One year Or Associate Member’s Subscription of RM500.00 for One yea

DECLARATION
We, the Company named herein, do hereby apply for election as Ordinary / Associate* Member of the Association of Marine Industries of Malaysia. We declare that all the information provided in this application is, to the best of our knowledge, correct.
We undertake, upon election, to abide by all the Rules, Regulations and By Laws of the Association.

Submitted by:

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Signature Company Stamp

Name : ______________________________

Designation : _________________________

Date : _______________________________ * Delete as appropriate

PROPOSER	SECONDER
...................................................... Signature Name:............................................................. Designation:.................................................... Company:........................................................ AMIM Membership No.: OM/............................	...................................................... Signature Name:............................................................. Designation:.................................................... Company:........................................................ AMIM Membership No.: OM/............................

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OFFICIAL USE
i	Date Received
ii	Application No.
iii	Date Approved
iv	Membership No.
v	Receipt No.
vi	Notes

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