ASSOCIATION OF MARINE INDUSTRIES OF MALAYSIA

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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 BACKGROUND

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 Principal Representative
to AMIM
Designation
Telephone no./extension
Email Address

___________________________________________
___________________________________________
___________________________________________

4.3 Alternate Representative
to AMIM
Designation
Telephone no./extension
Email Address

___________________________________________
___________________________________________
___________________________________________

5. Section 5: HUMAN RESOURCES

5.1 Management

M’sian:________

Foreign:________

5.2 Staff

M’sian:________

Foreign:________

5.3 Permanent Labour

M’sian:________

Foreign:________

5.4 Contract Labour

M’sian:________

Foreign:________

5.5 Total No. Of Employee

M’sian:________

Foreign:________

6. Section 6: FINANCIAL

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 8.0: SHIPBUILDING & REPAIR FACILITIES

	FACILITIES	1	2	3
8.1	DRYDOCKS
	Size (meter)
	Capacity (dwt)
	Year build

8.2	SLIPWAYS
	Size (meter)
	Capacity (dwt)
	Year build

8.3	FLOATING DOCK
	Size (meter)
	Capacity (dwt)
	Year build

8.4	SHIPLIFT
	Size (meter)
	Capacity (dwt)
	Year build

9.0 TYPE OF VESSEL BUILD/REPAIR (Please V )

	VESSEL TYPE	STEEL	ALUMINUM	FIBERGLASS	WOODEN
9.1	SHIPBUILDING
9.2	SHIPREPAIR

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:

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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

AMIM's Background Management Committee 2006-2008 AMIM's Members
Membership Application Guidelines Membership Application Form HOME
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