MDBC MEMBERSHIP APPLICATION FORM 2016
Membership Fees are payable on an annual
basis, valid from 1 January to 31 December;
after 1 July the membership fee for new
members is pro-rated at half the annual fee.
COMPANY INFORMATION
Company Name:
Address:
Post Code:
City & State:
Telephone:
Fax:
Company E mail:
Website:
Year of Incorporation:
Locally Incorporated:
(If Other, please specify)
Number of Staff
Memberships are automatically renewed in
January of each year, with invoices mailed out
during the first half of that January. Should
you wish to discontinue your membership for
the following year, please notify us in writing
before the end of December.
MY
NL
Sdn. Bhd.
Berhad
MY
Rep. Office
NL
Other
Global
In order to provide you with the membership services that the Malaysian Dutch Business Council (MDBC)
has to offer, it is necessary for MDBC to process your personal data. You and applicable colleagues from
your company will be included in the MDBC e mail database so that you will be able to receive our
information and event announcements. By filling in this membership form, you are stating your agreement
to allow MDBC to use and process your personal data and that of your applicable colleagues. Your
personal data is important to us. MDBC is committed to ensuring that your personal data is used and
protected in accordance to the applicable laws and in accordance to our Privacy Policy (which can be
viewed at any time on the MDBC website: http://www.mdbc.com.my
Please make all cheques payable to Malaysian
Dutch Business Council and enclose with
MDBC application form to: (or email to
info@mdbc.com.my /
fax 03-21418335)
Malaysian Dutch Business Council
Unit 808, 8th Floor
Wisma Lim Foo Yong
86 Jalan Raja Chulan
50200 KUALA LUMPUR
MEMBERSHIP TYPE (Please choose one)
CORPORATE MEMBERSHIPS (BASED ON PAID UP CAPITAL) (for companies in Klang Valley and Northern Region):
√ LEVEL
MEMBERSHIP FEE
DESCRIPTION
* Large, multinational companies
Gold
RM 5,000
Silver
RM 2,500
Orange
RM 1,500
* Paid up capital RM 10 million and above
* Four representatives may be appointed to MDBC functions
* In official meetings, Gold members have one vote
* Paid up capital between RM 1 million and RM 10 million
* Three representatives may be appointed to MDBC functions
* In official meetings, Silver members have one vote
* SME company with paid up capital below RM 1 million
* Two representatives may be appointed to MDBC functions
* In official meetings, Orange members have one vote
CORPORATE MEMBERSHIPS (BASED ON LOCATION / OTHER):
√ LEVEL
MEMBERSHIP FEE
DESCRIPTION
Outstation
RM 1,000
* Any company inside Malaysia / ASEAN, but outside the
(Malaysia / ASEAN)
Klang Valley area or the Penang/Northern Region area
* In official meetings, Outstation members have one vote
Outstation
€ 250
* Any company in the Netherlands
(Netherlands)
* In official meetings, Outstation members have one vote
INDIVIDUAL MEMBERSHIP:
√ LEVEL
MEMBERSHIP FEE
Individual
RM 1,000
REPRESENTATIVE 1 (PRINCIPAL REPRESENTATIVE)
DESCRIPTION
* For individuals only (No corporate representation)
* In official meetings, Individual members have one vote
MR / MRS / MS
Unit 808, 8th Floor, Wisma Lim Foo Yong, 86 Jalan Raja Chulan, 50200 Kuala Lumpur, Malaysia
Tel: 03 2722 8335 Fax: 03 2141 8335 E mail: info@mdbc.com.my Web: www.mdbc.com.my
FIRST NAME
DESIGNATION / JOB TITLE
TELEPHONE (DIRECT LINE)
LAST NAME / SURNAME
NATIONALITY
E MAIL (DIRECT)
REPRESENTATIVE 2
FIRST NAME
DESIGNATION / JOB TITLE
TELEPHONE (DIRECT LINE)
MR / MRS / MS
LAST NAME / SURNAME
NATIONALITY
E MAIL (DIRECT)
REPRESENTATIVE 3 (FOR GOLD & SILVER MEMBERS ONLY)
FIRST NAME
DESIGNATION / JOB TITLE
TELEPHONE (DIRECT LINE)
MR / MRS / MS
LAST NAME / SURNAME
NATIONALITY
E MAIL (DIRECT)
REPRESENTATIVE 4 (FOR GOLD MEMBERS ONLY)
FIRST NAME
DESIGNATION / JOB TITLE
TELEPHONE (DIRECT LINE)
MR / MRS / MS
LAST NAME / SURNAME
NATIONALITY
E MAIL (DIRECT)
BUSINESS SECTOR (Please select ONE Primary Sector (P) and any relevant Secondary Sector (S))
Agriculture & Timber
P
S
Chemicals, Cosmetics, Medical & Pharmaceuticals
P
S
Construction & Infrastructure
P
S
Consultancy & Services
P
S
Consumer Products & Appliances, Food & Beverage
P
S
Corporate Services, Financial, HR, Insurance, Legal
P
S
Diversified Conglomerate
P
S
Education
P
S
Entertainment & Production
P
S
Exhibitions, Hospitality & Tourism
P
S
Government Statutory Body
P
S
ICT
P
S
Logistics, Transportation, Distribution & Storage
P
S
Manufacturing
P
S
Oil, Gas & Power
P
S
Trading
P
S
BUSINESS ACTIVITIES (Will be published in the MDBC magazine, MAX 120 words):
NAME: ………………………………………………….
DATE: ………………..
DESIGNATION: ………………………………………..
SIGNATURE / CHOP:
Memberships are automatically renewed in January of each year, with invoices mailed out during the beginning of the new year.
Should you wish to discontinue your membership for the following year, please notify us in writing before the end of December.
Unit 808, 8th Floor, Wisma Lim Foo Yong, 86 Jalan Raja Chulan, 50200 Kuala Lumpur, Malaysia
Tel: 03 2722 8335 Fax: 03 2141 8335 E mail: info@mdbc.com.my Web: www.mdbc.com.my