Chartered Secretaries Malaysia (MAICSA)

Updated: 23 Nov 2021

Online Application : Chartered Governance Qualifying Programme (CGQP) (Page 1 of 6)

The online form will prompt you to six (6) pages
Please use these forms to provide MAICSA with information to support your application
Please use the EDIT button at the bottom of the screen to key in the information
When you have completed the forms, please use the PRINT button at the bottom of the screen to print out the information that you have keyed in or click on the SAVE button at the bottom of the screen to save the data
The saved data will be purged from the MAICSA Interactive after one (1) month
Click on the SAVE button and NEXT button at the bottom of the screen to continue next page
Students are required to submit the hardcopies (page 1-4) of the application form together with the supporting documents, within one (1) month to the Institute, failing which, the submission will be invalid.

APPS 001/2020

The Malaysian Institute of Chartered Secretaries and Administrators (MAICSA)
Bangunan MAICSA, No 57, The Boulevard, Mid Valley City, Lingkaran Syed Putra,
59200 Kuala Lumpur.
Tel: +(603) 2282 9276 Fax: +(603) 2282 9281
Email: students@maicsa.org.my Homepage: www.maicsa.org.my

STUDENT REGISTRATION FORM

(A) ENTRY

Please tick (

) the programme you wish to enter at

Chartered Governance Qualifying Programme (CGQP) MAICSA Collaborative Masters Programme

Fast Track Route

(B) PERSONAL PARTICULARS


Please complete all sections of the form in block capitals and in black ink.

Name
(as per Identification Card)
Other Names Gender		Marital Status
		(single / married / other)
Title		Honours
(Mr, Ms, Mrs, Dato', Datin or please specify other)		(FCCA, FCMA, ACCA, ACMA or please specify other)
Date of Birth	Nationality	Race	Religion

New IC No		Old IC No
Residential Address (permanent address)



Town	Postcode	State	Country

Mailing Address (for MAICSA correspondence if different from the above)



Town	Postcode	State	Country

Telephone	Mobile	Email

Are you currently in full time employment?		Yes	No

Name of Company

Job Title		Date Joined

Company Address



Town	Postcode	State	Country

Telephone	Ext	Fax No

Email Address		Type of Organisation

Can we provide your employer with details of the ICSA programme?			Yes No
If yes, please confirm the name and job title of the individual you wish us to contact

Name		Job Title

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