KËMËNÏËRIAN LUAR NEGERI
REPUBLIK INDONESIA
NOTA DINAS
No'¡ or, JZIB rtõüõ7 20 1 s t 2,2
Kepada :
Tetrbusan
Dari
:
Larrprrarr
Perihai
Yth. Sefuruh Unit Eselon tl
Yth. Sekretaris Jenderal (sebagai laporarr)
Kepala Pusal Perrdrdikan dan pelatihan
'1 (satu
) bcrkas
l awaran Beasiswa Program Pelatihan Kerja sama Teknik Perrerintah lValaysia
Tahun 2015
Merujuk perihal tersebut pada pokok Nota, dengan hormat disampaikan hal-hal berikut.
Pusdìklat tefah menerima surat dari Plh. Kepala Birô Kerja sama Teknik Luar Negeri
Kernenterian sekretanat Negara mengenai penawaran program pelatihan Diplomatic
Training Course for ASF:,AN JLtntor D¡ploma¿s dari pemelntah Malaysia.
Ponrerrntah f\,4a1äysiâ al<an ntenanggung selìluh biayi.r selrr.rbunç;an clerrgarr keil<utsenaa¡
pada program pelatihan tersebut
Adapun persyaratarr untuk mengikuti program beasiswa dimaksud adalah sebagai berikut
a
b
c.
d.
e.
Dicalonkan oleh unit kela rlasing-nrasing melalui Nota Dtnas;
fi.ilenyampaikan Daftar Riwayat Hidup terbaru dalanr bahasa lngoris,
l\,ilengisi Formulir Pencalonan rangkap 3 (tiga) diisi lerrgkap darr diketik rapi serta
disetujui oleh oleh Pimpinan unit Eselon ll pelamar beasiswa derrgarr dilengkapi 3
(tiga) buah foto benryarna ukuran 4x6 CM,
Medical repol1 yang d itarr<latarrganr oleh <jokter yarrg berwenang,
l\,4ampu berkor¡unikasi dan menulis dalanr bahasa Inggris yang clibuktikan cienqan
hasil nilai tes TOEFL l1 P mrninral 4S0
Bagi yang bern'ìinat untuk mendaftar beasiswa pelattl.ìan dirnaksud, dapat segera
merrgirrmkan nota dinas pencalonan beserta tiga rangkap isian formulir pendaftaran darr
persyaratan lainnya ke PusdÌklat. Batas akhir penerimaan dokumen pencalonan oleh
Pusdiklat palirrg laml-rat f (satu) bulan sebeium ciimulainya pelatihan dì¡naksurl.
Dernikian disarnpaikan, atas perhatian dan kerja samanya diucapkan ienma kasilr.
Jakarta, 3/
J
uli
201 5
NIP 19550729 198403 1 001
TARGEf GROUP
RULES AND RÊGUIATIOI,JS DURING COURSE
junior ¿irlomaE ånd Eoyernñenr ollcers whose rzsks an¿ funcrÍons are
reiêted ro.iipiomecy zñd rnrernarion¿l relárioñs eñC secürirI and
ø
All p¿rticipãnis
ê
l.onì IDFR and ICFR h¿s ihe
ând the oiíêr to êtÌe¡d ih 5 co!.se ior ¿nv i;te.uraer
¿efe¡se mã¡agèi¡enr.
LEARNING OUTCOMES
ey the end ol thìs co!.se, ihe particlpanis sholld be ¿bLel
.
io provlde e)(posu.ê io ihe p¡riicipa¡ts on cureni cev€iopñrenis
any of thE sched!led prosrañlmes durìng the course
r¡ drplom¿q, añd internat'o¡¿l relaiions
.
r.f.ust a.:iv€ l¡ M¿lavsiâ n. tãter th¿n rhe date oí
conmencÊment cf the.
expressly given permiss;on
b_! ihe nstiiut€. Latecoreß wili ¡oi recei!e ¿ ceriifìc;te of
¿tie¡dênce
lÐ erhê¡ce opêr¿iion¿l ski:ls a¡ci expertlse
¡
rhe
ío: ¿ny re¿son is sTRICiLY PROHtSITED v¡tthoui Ðr¡or permjrsjoñ
from the l¡stituie a¡d c¿lt:cìpãnis ú.ho are ¿bs€ñt for ñore ih¿n
pa.forñ¿¡.e ci
iwo
12) d¿ys WILL NOT re.eive a c€rtific¿te ôí aÍendãnce.
l\4PORTANT|A p¿rtlcrp¿ñts are exoecteC io mainiài¡ ¿ high l€v€l
oí p¿ñicip¿ì¡on dLring ihe e.iüres, â¡d cc¡ducr ih.mselves in ân
¿greeåble m¿nner amongst therr peeß. Anj,, show oi poor
!o.d!ci, for e!âmple be:ng ¿ggressrve/ r!ie and lack of
coop€.atio. wjil be tieêieC s€rìously, with ;ñnredi¿ie noiii'cêiio¡
to ihe pêriìcipênß mission rn M¿i¿ysi¿ ãni ìheir respective
M n ttry ol Foreien Affâ fs TNe l¡siit,Ji€ w: I ncì hesiraie to se¡ê
¿¡y Ðroblem¿tic p¿rt c p¿rts back ic iheir:ô ¡try cjurjng the
Curãtio¡ of ihe course.
dLriÌes ¿s dipiomaiic offÌc€is
ô
encaur¿gE beit€. u¡d€rsia¡drng, ¡€rv/orkrn6 ¿nd cohesto¡
emong young ASEAN Ciplom¿i! fôr ê heêi¡hy cross-ilotr, cí de¿s
.
to e.omote ên Incre¿sed ASEAN rCeniitv êmong ih€ p:r¡crpa^is
iiai wi:i coni.bciÊ iowê.cis ASÊAl; ccñm!nrrv buÌldiñã i¡ lìnê
lo
¿¡ coniêcis foí tui!re cooDeraiio¡; ¿ni
v¡rih the ASiAN
Ch¿
rici.
COURSE MEIHODOLOGY
MAE-AYS¡AN TECÈJNICAI-,:
OOORPERATION PROGRAMMÉ (MTCP}
AL pêrircip¡nîs ar€ expecr€d
ìeciures, sjrlul¿iron exer.rses, siìrdy vìsite ê¡d prôle.i
p¿p€r pr€seitãiÌoñs lornr añ integ.¿; p¿(.i th€ couße. The ir¿rnina
¿pprc¿ch !v'll enccn¡¿ss bôth iheoreÌicê ê¡d pracric¡l ¿soecis lo grve
p¿rilc:¡âr'is ¿ lvhol€ new ie:rning expe.ìence. -ihe couße wiii be fully
concu.red i¡ Englìsh
D scussions,
êrr¿nged throughout ihe
iu.¿¡on oi ihe c!rrs€.
Pêfjcipanrs must obsÊr!-- pLrnct!alÌry êi êjiii¡ììes. ihôse who ere
lâie or mss ihe lDËR irânspo¡t nrusi finc iheir ovr'n way to rhe
lnsiliuie ia ¿ttend th-- l€ctur€s. or will oì¡erwise be considered
rg coü3e
rs v.iorkinS
¿ii:i€
COURSE CONTENT
i.troductÌo. io
ASEAN
PREREQUI5ITE
/
ETIGIBIIITY
rierested applicênis
lñiroductio¡ ic M¿lêvsia Staie level co!€r¡ãnce
N.rn
ñ:iei
ñlst
lrliLli th€
by thei. Go\
ASEA¡J G€oÐoliiic¿l Rel¿iions: A Psychologic¿i P€.spective
i1¿ve è bêsic univeßiiv .ìêgreÊ;
liier¡¿tLcn¿lEccncñic¿.d
BÈlow 35 y€aß of ¿se;
Fegion¿: Cooper¿ilÕ.
aid
rrade lssies
sec!,riiy i¡ ihe iir¿iis of Mel¿k¿
¡i€r¡alronâi Negoii.ìion5
L;¡guage & Diplôriãcy
owi¡g crrieria
ih¡ee ye¿rs or mor€ aíL!o.kinE
êiionêr irade; or secur¡ir ¿nd d€iense m¿nâg€
Deve opmani
Añbassedor Leciuie Ser:es
foL
e¡¡..e¡i;
ø
4
Pioficie¡t in
'
Air.llîy to work i¡deo€nae.Ìly anci in grouÐ:.
Сplornat¡c Tra¡ning Course for ¡.SE:Åg'l
..tunior Þip!ornats
l2 - 30 ocToBER 2015
English LêngJ¿Ee,
Med c¿ily íii; ¿¡d
Prblic spe¿¡(int and ?reseñt¿iÌon 5k:Ìls
,eite.s i¡viiìn€ luro noi¡Ì¡êi o.s írom
N.l¿lêysl.'s
f or€lg11
€¿ch AsEA\ ñember cauntry wri
ire s€ni by iDiR 1o ali ASEAN añ',bas3:es/ ïigh C.rnñisions et le¿st twc
P.;icy
ñc¡ihs beio¡e ibe ccm-en.er¡ent ol the couÉe AJI appllcan$ must
be iñ ihe slênd¿rd êppll.¿t;or foim õbt¿r¡¿bi¿ fr.m l0FR's website
Biue Oce¿n 5i.¿ie8y
ltsues on CouniÊ
r
ieirorÌsñr
ñlediâ Re;¡tions ?¡d Mediê Ski
s
LOGrSlrCS
APPIICATION DAIEtINE . 1S€tieñber 2C15
ihioL/8iìout the course
Mr
CONIACT PERSON
H¿rìs
syã^vàni
R¿z¿ii
MEO¡CAL
-¡he panicip¡nts
êre eniiiled iôr åñ r¡s!ra.ce coverêge ihrcugholr Ìhe
course ¿nd rnedical ifeai¡nenì íor ouip¿tient medical ire¿irnent à1 lcca
Ê.vernrenì hospirêls. other nredrc¿l co5l shal; be bo.¡e by ihe
: Teii : h¡rjs@idfr-sov-ñy
Íei
: +6c3 2i49 1000.
Fê):: 1603 2145
ic1s
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r:lr',lj.]Yi
'
i:
aM¿lã),siâ ls locat€d in iñe so!iheasi of ìh€ AsÌan conti¡eit; i¡ereíore
rhis reêÌo¡ ;s ciie¡ refe¡red to as Southeest Asi¿. Melaysi¿ consists oul
Ihe Mðl¿ysj¿n lechnica Cooperôtior Progr¡m {MTCP)
in 1980 a5 Malåysiê's ccrmìtrenl to Souih 50lih Cooperêtion through
ih€ shêrirg of M¿l¿ysÌê's developmeñt expeiìe-ce! ând expertise with
cther developing countries
Ìh€ rsiriuie oi
Re etrons, ¿iso kr..iJ ì ;s rìi:
r¡¿cr ihe ?r,me \4i¡ !r€1s tê?¡.i:r.ii
fÕlicv/ing ¿ Cèbi¡et d:.'sio¡ cêisd 6 if¿¡ciì i99: it rr:s .ííi.i¿l:!
Orpicm¿.y
v¡s Êsi¿bisleC o¡ I luÍ
aid ¡:or:Lg¡
1-Qgi
in.ì s¿iìr€ ye¿r on 12 ÁLgLr5t by t¡e iien P.;-Ê M,r,;!.r r¿i.'
t.. rL4?heth;r Mol-r¿¡rãi O.2/^ ili2ich 2aC1 IDFÊ oÍ,..lr'i.^.¡rì:,
pt¡i .i iie Vi¡lst.{ oi;oregi Ai:¿i: o: M¡iâysiâ. Lc.â:.. : i;r¿Ì.
L.rnÊür, lDil ,s hou::d ì¡ lhe r¡i-er buiiCl¡€ ôí th,â FcrÊ,8i r(,i,slrr.
lãurìchei
Se¡r
lhe objeciives ot the MICP:rei
6 Ío shê.e experie¡ce wrti cther .ieveloprng .cunkies;
6
ê
is nL-1/.¿rpus
To si¡engihen bÌl¿1er¿l ir€s !vrth developing couniries;
!r¿5 opê¡ed
i¡ 2tc6.
Io erìcour¿gê ã¡d rron.te Soùih So!th Côoperationj ãnd
technÌcal coooerêtìon within
.jeve oprnB cou¡t.ies
iwo ¡ê].is: Peii¡sula. ivl¿iêysl., located beiwee¡ Thâilênd in ihe north
¿nd sinB¿pore in ihe soL,ih, ênd ih€ tlvo rrovl¡cês Sêbah ê¡d S¿rê\¡/¿k,
locaiei onEorneo. Peni¡5u¿r MâÌeysi¿ is locêtÊd j,r3i ¿bove ihe
eq!aior and Borreo lusi Seneãth ri. The c¿prtâ: crty is Ku¿i¿ L!ñp!¡,:
r1êi¡opolis with over 1.6 mÌliion inhsbìianìs in the c iy c.nter.
il
ri¿ies (11 Ìn lvÊsi Mê ¿ys;a
¡¡o k.owr es Pe¡i.s!l¿r irãi¿ysi¿, ¿nd two ttêtes i. t¿si ilr¿ìðvr¿) ¿¡d
i¡¡ee fede.ê ierrÌioíes. As a feder¿tio¡, rhe govern¿¡cE ci thÊ co!.¡ry
¡¡al¿ysrè rs ê feder¿i,.n !v¡rch .onslsîs of
is Civjied b€tw€en th€ íederâi ênd ihe stète governme,rîs. lhe
ivlTCP ìs pren1ised
o¡ the priÌì.lpie thêÌ t¡e
Ceveiâp.r'€nt of ¿ country ìs
iependeni on t¡e qüâ|ay oí rG hum¿n capùal ¿ni ¡esorrces. MfCP
e.¡ph¿si¡es humãn resourcer developirent ñ; nly through tr¿Ìning,
short terñ .ours€s ic publl. ¿cC privère Mê ¿y5r¿n rèining i¡siitutions
end Ìon8 ìe.m cou.ses ;n Ma,¿,/siar public u¡iv€rsìiies Other forms cí
¿ssisi¿nce inc ud€ siud-v visi3, prêdicêl aitachle¡ts a¡C provision cf
gover¡¡l1enÌ system ¡ oarli¿meni¿ry democr¿cy wrih ¿ conslrlLr¡o¡¿
ñonêrch The head ol staie is DYMM Yãng di-Pe.i!¿n AConS aìrd
poj,ticêigovern eñ¡ is h€åded 5y Pflme MinÈier.
SÌnce it,< incepilo¡, fro.e ih?n 29,C00 p¿riicìp¿¡i5 hêve been direcil),
irêìned und€. [4ICP. Cufie¡ly MTCP is exiended ìc i40 r€cipi€nt
developlns cocntnes i¡ ien ilc) k€y ãre¿s ¿s fol owsi
a be¿utifui ¿nc div€rse côuñtry ir,¡ih m¿ny hiEhlighis. fh€
ñ¿¡y ¿rffere¡t reglons, eacir with iheìr osn .hãr¿cteÍ5trc 퀿iur€s,
m¿ke ihrs .ountry inê perfect desiinêiicn for io!rÌsrs. lrclv€v€r,
Mêlåysia does
eniÌrely depen.j on tourisr¡. Ìhis co!rntry! ecoñoñy
^oi
h¿s bÊÊ¡ gorng sro¡g foi ye¿ß. the colrntry h¿s deveiop€d riselí
€ôorñolsly in the pasi 5C ye¿rs, especr:ly ìn M¿l¿Ysi¿'s .âpira, Ku¿12
L!mpur, m¿ny ñode¡n bu,drnes, ê ñìoder¡ ll8hi rài ir¿nsit sysiem,
Í,ârìy luxurìo!s shopping Íì¿llsand co!¡tles5 expensrve .ârs o¡ ihE
roêds Lile or-rtsi¿e oí the.¿pitêi is olieñ less deve opedj bui ever ihe.e
ih€ iìmes of o€opje ony being âble:o afford ¿ mctorcycle ¿r€ lon8
o
Economíc, iin¿n.e ¿¡d Tr¿de,
ø
lndustrÌ¿; iechnÌcâ T.â'rr¡g;
ð
o
6
o
Mð¡¡tement ¿¡d
tu1¿l¿-vsi: is
Me:evsiê is ê t¡opica hoiìdêy desii¡åiion, where ieñrter¿turEs fi!ctuête
beilveei25¿ni35degrees ceiciusduringlheye¿¡. liis Lrsuallyvervhoi
¿nC hr]i¡lc, €specì¿ll!" ji t¡e rn.jor cliìes. Ofîen due to h¿ze v¡:rn'ì ¿ir is
ireppeC inside ihÊ citÌes, ,(¡ich resulis In vÊry w¿r.n iemperaiuies. li rs
ess hoi on ihe m¿ñv Ì51¿nis surrourd;nB M.l¿ysi¿, m¿r¡i,r duÊ io ihe
.oô brêe¿es. it ls alsc les! hot in ihc 'hÌehlên.is of Mê ¿ys,¿, hÊre YoL'
.¿n €nj.y cool€r tempe.¿iures ihal nev€r ex.eei 25 degr€es celsi!s.
ihe
DiR.riris? si:aeii! ¿ri i.:rrÊ!s i¿'/e
?st
Publ,c
Adm'¡liir¿iion;
Proíessio¡êi ¿fd S€iv;cesj
S.Ì€nce, iechnologt/ ênd iCl M¿nège-ent.
a nÊw .lrrec¡on íor ihe \¡TCP ,ras formuiaied Ío Iowing its plè.emenl
Dði€ i i2
,rrCer Wi5m¿ Purra ì. 2010. lt eniaiis oria.iti¿ing cìevelopÌng cou¡t.ies
oí 3trâregic rñt€iests, foc!sÌrg cn Mal¿ys:ã's ¿re¡ cí exper'tise, d€mand
drv€r coùrses/!ro8rammes,.ultrv¿ì'c¡ ôi poi.riì¿l pê|tlcipants who
\!ould later scrye as 'ír;ends oí Mêlêysiê', pu:ìic-.orÌvaie partnership
iFPP)¿rd coll¿bor¿tion (Ìih .evr' o€v€lopñe¡t r¿rtners beyo¡d MTCP's
ifêditione parine¡s
Venue:iñstituìe of Diplor;r¿cy ¿nd Foreign Relations,
lralli
glv€ more attention
Oil
lnCuslry, Food ¿nd Eeverêges. H¿l¿l Economy:rd Ecosysiem, lsl¿rnjc
i_i¡ê¡ce ånd Sâ¡iing, ECucêtlon, Constructio¡, te¿lih se¡vic€s, Djploñ¿cv ênd Gover¡¿nce.
Currency
RlngEìt l4alaysìa (Rful)
io
G¿s lndustry, Products
anc Services incudins 5mal ù4edium Êrterprses (SMEs), P¿lm
5a.4% l4alay, 231% chinese, 11.Ð% lndìgenous, i.1% )t,¿Ên & 1.8%
Other
1
llalaysiân Ringgit (tulYR)
fg s.ho:¡- ¿i.i i¡ie¡ìairo¡¡ ê¿icß. l:r-ìne4i spÉ-rrÉ.! r::r¿
lr¡;i. !€.:.rre 5er es h¡v. :rciua--.i lcíÌAnrâr. H;í5 :,1¿a?,. i.i
IDF¡'s
5..iãl Developmeni, ¿rd
F¡am the 1en key bro¿d ¿reâs, ihe MiCF
Ethnic
pårì1.üiêr ia parijclp.nis ;.om ih. iey? oÊirg ccr ìir Ê! riar:
i\4¿ìaysi2ìr iê.hn.¿l Coope:¿i o. Prog12rÌrrìê (\rlrcP ¿3 fol ,
iicn,lSÉAN, acioñb; Fl¡n ê.d aonrmcrú¿;li:r.o!¡irle!.
ihe foliawrng €ieve¡ sub'ãreês n¿.¡eJy Oil ¿¡d
28.3 mllion
!¡ie, ì
30 cctober 2015
KuaLa
ir-p!r
AfM
¿inìs io provide exÞosure cn th€ v¿riou5 êspecis oi iheciies,
eËci¡ces a¡C elemenis oÍ Cipicßac), ând Ìntern¿iÌon¿l atrèk3tÕt
ihe côurse
¿spirlng ASEAN Junior Diplom¿Ìs
RATIONALE
ln iodày's vr'ond where the essen.e ¿nd pracîice
ôí.jipiom¿cf elìd
foreign relauons have evoked and ¿re ever ch¿¡Aing, d¡plon ats need io
equip thefirselves with th€ right knowl€.jge ¿nd skìlìs ic' í¿c¿ th€se ¡ew
chaÌlênges. This three-week course sets
to meet thêt challe¡ge. li eims
io up8iade ih€ siandard of profess'ô.a1i5r¡ ¿¡d effectivenes. oi
Ciplom¿is in ihe perfoírìa¡ce oí their outies at home and ¿broaû the
lnstituie hop€s to conlribuie tow¿rds ef'orts u¡dertaken by develcirl¡g
countries io.reête ê weil'.ounded corps ol professional ¡ñd skilied
drploñêiic cífrcers whc cê. eflect¡veiy promoie therr cou¡tftss'
i¡terests in lhe
åren¿.
'atern¿tionãl
.r.#k,
iÉff,'òi
'/r.\-E5Fes*Z,i
Please affíx
?rff,r+,"
passport
photograph
APPLICATION FORM
FOR OFFICIAL USE ÕNLY
SHORT TERM COURSE IN MALAYSIA
UNDËR THË |I4ALAYSIAN
ïECHNt0AL 000pERAT|0N pR0GRAllilME ( frlTCp
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form sho.rd.be dury compreted and endorsed
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[4ajor f¡eld of sLudy
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balary per month (us Dollaii)
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NoTE ; This applicat¡on fonn should be duly completed and endorsed by the Min¡stry of Fore¡gn Affã¡rs
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not endorsed w¡ll not be accepted
or the Nat¡onal
R.CASOñI5 FOR AFPLVTNG TI-'ITS CQL!RSË
Pleäse sl.ate llnefly the reasons
lbr applying to
tl.ìis colllse and ho\,v you hope to l]enefit frotn the progritnnìe.
_---.Pl-e_q:-e_ç9r.t-tingg,sn
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NOTË : lhis appl¡cat¡on form should be duly completed and endorsed by the M¡n¡stry of Foreign Affa¡rs
or the National Focal Po¡nt for Techn¡cal Assistance in your country, Forms wh¡ch are incomplete or
not endorsed wifl not be accepted
MEnIeA¡- RËftORT (to he c$ropleted !:y an auttrorizecl ¡rh\¡sician)
Nanìe of AÞÞlicant:
Age:
Blood PressureÌ
Blood Group:
ffio [.J u ffiou f-f o ffiu*"'-1
Is the person examined at present in goocj health?
Is the person exam¡ned physically and mentally able to
carry out intensive traininq away from honte?
Is the person free
diseases (AIDS,
tuberculosis, trachoma, sk¡n diseases etc.)?
Does the person examined have any
or defect
(including teeth) whlch might require treatment during the
cou rse?
List any abnormalit¡es rndicated rn the chest X rav.
Pregnancy Test
for women ):
I ceftify that the applicant is medically fit to undertake a course in lvalaysia
Name of Plìysician
Address of Cl¡nic
(printed)
Telephone
(printed)
Email
Date
Signature of Physician
Seal of Clinrc
applicàtion form sholld be duly completed and endorsed by the Min¡stry of Foreign Affa¡rs
Focal Point for T€chnical Àssistånce in your country, Èorms which are incoñplete or
not endorsed w¡ll not be accepted
NOTE : Th¡s
or the Nat¡onal
APF!-TEAN¿T'5 ÐEC¡.AR.ATNO
ru
Name of appl¡cant
Representing Country
Declare that:
a)
b)
c)
d)
Alì ¡nformation provided is true, comÞlete and accurãte to the best of my belief and knowledge, and that I have
not wilfully suppressed any rìaterial facts;
I am medically fít and free from any medical problems wlrrch may impair my ability to attend and cornplete tlre
training in I\.lalaysia;
I will be personally liable for alt medical expenses due to pre-existing conditions/illnesses incurred during nry
stay in fvlalaysia âfter my admission to any ¡4alaysian government hospitals/cl¡n¡cs, and âlso other than those
covered under the Group Persorlal Accident Insurance. (All successful part¡cipants arc covered under Group
Personal Acc¡dent. The Group Personal Accident does nqt cover any Þre-exist¡ng condìtions/illnesses or any
outpat¡ent medical/dental treatment. Participants are personally Iiable for medical expenses beyond what is
covered by the insurance policy. As the coveràge is lim¡ted, pärtic¡pânts are advised to mãke their own
arrangements to obtain adequate medical insurance coverage for the¡r stây in Malaysia;
arrd
For pregnant female applicants only: I am
months pregnant and am/am not certifìed by a qualiÍed
doctor to be medìcally fit and in good health to travel and attend the training in lvialaysia
Upon successful selection for the tra¡ning award, I unclertake tol
a)
b)
c)
d)
e)
f)
-
carry out instruct¡ons and abide by such terms and conditions as may be stipulated by the nom¡nat¡ng and host
governments in respect of this traìning course;
abide by the rules and regulations of the training institution in which I undertake to study in or lle trained under;
submit/present any repod which nray be required;
refrain from engaging in political activities ¿ìnd any form of employment for profrt or qain;
return to my home country upon completion of the training; and
dìscont¡nue tlìe course should I lle found gu¡lty of misconduct or be nledically unfìt.
I fully
understand that if I fail to company with the terms and cond¡t¡ons of the training award, and/or any of the
above declarations al'e found to be untrue, the awârd will be terminated w¡th ¡mmed¡ate effect and I will be liable to
depaú from N4alaysia at my own expense.
Signature of applicant
NOTË : This appl¡cat¡on
form should be duly completed and endorsed by the Min¡stry of Foreign Affairs
Focàl Point for Techn¡cal Ass¡stance in your country. Forms which are incomptete or
not endorsed w¡ll not be acceÞted
or the National
T'(}; G{)VHRN MHN'I' 0F MAù.qYSrÂ
Passporl
Number:
havinq an address at
_, hereby declare that I shaìl be personally liable for and shall indemnify the
Government of lvialaysia and
against
all liabilities, claims, losses,
demands.
actlons, sllits, proceedings, costs or expenses, in part/total, whatsoever arising under the laws ol'lvlalaysia or common
law which may be m¿ìde or tal(en aga¡nst the Governnrent of [4aláysia
n,,d/o,.
".r,r,,,
or ¡ncurred or become payable by the Governmerìt of ¡4alaysia and/or
,,,rr;,,r*,,*
¡rì respect
of any
ofany medical ilÌness, personal injury (whether fatal or otherwise)/ or the death ofany person. by reason of my
carelessness, negligence, omission or default, in the course
is apÞointed by
Date(l this
of
my kaining with
the Goveíìnent of fvlalaysia.
_
day
___
of
20_
Sìgnature of applicant
Name of applicant
In the presence ol'
Signature of Witness
Name of Witness
Designation of Wttness
I/C or Passpoft No,
NOTE : Th¡s appl¡cat¡on
form should be duly completed and endorsed by the Min¡stry of Fore¡gn Affairs
Focal Po¡nt for Technical Ass¡stance in your coüntry. Éorms which'are incoriplete or
not endorsed w¡l¡ not be accepted
or the Nat¡onal
:tÛ,
T$ 6E COMPLETËÞ ßV'F¡.{E T{ÛMTNI\TTF{G
GÖVERNMHF,¡T
Reasons for apÞlicant's selection
fhe post which the appl¡cant will be required to fill upon satisfactory completion of training
Relevance of the course
to äpplicant's job
NoTE : This appl¡cat¡on form should be duly completed and endorsed by the Ministry of Foreign Affairs
Focal Point for Techn¡cal Ass¡stance ¡n your country. Forms which are incomplete or
not endorsed w¡ll not be accepted
or the Nat¡onâl
rcl
BE e0MP¡-ËTCþ [9V t-&.ie S{()M:(NAT[¡{G
Gû\lE[tiitMËl\T
OFFÏEIAL ÞËCLARATÏOS¿
on behalf of the covernment ol
Cert¡fy that
a)
b)
c)
d)
I
I
,
I _.
Nanre of
I
have examined the educational, Þrofessional or other certificates quoted by the applicant in this form and
I
am
sat¡sfied that they are authentic and relate to the ðpplicant
The apphcant is medically fit and free from infectious disease and that, havirìg regard to his/her ¡rhysical and
mental lìistory, tlìere is no reason to suppose that the applicant is other than fÌt to undeftake the journey to
lvlalaysia and to remain ¡n Malaysia for the duÍatron of training;
Should the nom¡nee seek medical consultation/treatment for his/her pre-existing conditions/illnesses during his
per¡od of stay Ìn lv]alaysia, he would be personally liable for all medical expenses incurred, other thân those
covered under the Group Personal Accìdent lnsurance; an
appl¡cant has attained a level of proficiency in both spoken and written English to enâble him/her to follow the
course of study/training for which he/she is being nominated.
-lhe
nominate ( Dr/ lvlr/
M
Passport No
rs/ Ivlsx
for the training course.
SÌgnature ðnd Official Stamp
Name and Designation
Naüle and O[gðrìisat¡ofl
Email address
-
C",,"Ly
Counlry
")(ia
code
Areiì
code
Ofllcc tel lro.
Area
(odc
Oflce tel no
Endorsement by the nominating country's Ìvlinistry of Foreign Affairs or the National Focal Point for Technical Assistance
Emaìl Address
( lvlinistry's Official Stamp )
Designation
Name of 0rganisation
Signatu[e
c"r"t'r *d"
Country code
Area co¿e
Area
code
Offrce tel no
Offce tel no.
form should be duly completed and endorsed by the Ministry of Fore¡gn Affäirs
Focal Point for Technical Assistance in your country. Forms wh¡ch are ¡ncomplete or
not endorsed will not be accepted
NOTE : This applicat¡on
or the Nat¡onal