Chartered Secretaries Malaysia (MAICSA)

Updated: 27 Jun 2019

Online Application for Admission as an Affiliate (Page 1 of 3)

The online form will prompt you to three (3) 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 1-3) of the application form together with the supporting documents, within one (1) month to the Institute, failing which, the submission will be invalid.

APPLICATION FOR ADMISSION AS AN AFFILIATE

(Please complete ALL SECTIONS in BLOCK LETTERS)

To the Council of MAICSA:

I hereby apply for admission as an affiliate of The Malaysian Institute of Chartered Secretaries and Administrators (MAICSA) and if accepted, I hereby undertake to abide by the Rules and Regulations of MAICSA pertaining to the Affiliate Scheme in force from time to time.

I do solemnly and sincerely declare that:

•

I am not an undischarged bankrupt

•

I have not been convicted whether in or outside Malaysia of any offence referred to in section 198 of Companies Act 2016;

•

I hereby consent to the processing of my personal data for the purposes described in the Personal Data Notice.

I hereby certify that all information given in this application and attached annexure(s), if any, are true and correct to the best of my knowledge.

Signature:

Date of Application:

Name (as per IC):

NRIC No.:

FEES PAYABLE ON ADMISSION

In support of my application, I enclose herewith a cheque / bank draft* Bank
Branch No. of RM being payment of:-

Admission Fee	:	RM100.00	(All cheques/bankdrafts should be made payable to "MAICSA")
Annual Subscription	:	RM225.00
Total	:	RM325.00

*Tick one only

FOR OFFICE USE ONLY

Date Received:	Application Serial No:
Checked By: (1)	(2)
Receipt No:	Date Issued:
Approved / Reject:	Date of Admission:

The Malaysian Institute of Chartered
Secretaries & Administrators

Bangunan MAICSA, No. 57, The Boulevard,
Mid Valley City, Lingkaran Syed Putra,

59200 Kuala Lumpur.

Tel: 03-22829276 Fax: 03-22829281

E-mail: members@maicsa.org.my

Page 1 of 3

Online Application for Admission as an Affiliate Page 1

Online Application for Admission as an Affiliate (Page 1 of 3)