I/We wish to apply for membership of the IKHTISAS KELAUTAN MALAYSIA (Association of Malaysia’s Maritime Professionals). Personal/Corporate details are as follows: INDIVIDUAL MEMBERSHIP CORPORATE MEMBERSHIP Name: ____________________________________________________ Company’s Name/Address: _____________________________________ Citizenship: ________________________________________________ ___________________________________________________________ Date of Birth: ______________________________________________ ___________________________________________________________ Passport No: ______________________________________________ Nature of Business: ___________________________________________ MYKAD No: ______________________________________________ Telephone No: ______________________________________________ Profession/Occupation: ______________________________________ Fax No: ____________________________________________________ Professional Qualifications (Please enclose photocopies): E-Mail: _____________________________________________________ _________________________________________________________ Academic Qualifications (Please enclose photocopies): COMPANY’s NOMINEE 1 _________________________________________________________ Name: _____________________________________________________ Home Address:____________________________________________ Designation: ________________________________________________ _________________________________________________________ Date of Birth: _______________________________________________ Telephone: House:____________________ HP:__________________ MYKAD No/Passport No: _______________________________________ E-Mail: ___________________________________________________ Telephone No: ______________________________________________ Name Address of Employer: __________________________________ Fax No: ____________________________________________________ _________________________________________________________ E-mail: _____________________________________________________ _________________________________________________________ COMPANY’s NOMINEE 2 Telephone No: ____________________________________________ Fax No: __________________________________________________ Name: _____________________________________________________ E-Mail: ___________________________________________________ Designation: ________________________________________________ Date of Birth: _______________________________________________ MYKAD No/ Passport No: _______________________________________ Telephone No: ______________________________________________ Fax No: ____________________________________________________ E-mail: _____________________________________________________ Note: Successful applicants will be notified on procedure of banking in the RM 50.00 Entrance Fee and appropriate Membership Fee once approved. SIGNATURE: …………………………………………………. NAME: ________________________________________ DATE: _______________________________ M E M B E R S H I P R E Q U I R E M E N TS Every candidate for election or transfer to the class of Ordinary Member shall satisfy the Council of the following: Ordinary Member Is a holder of one of the following qualifications or equivalents; o Master or Chief Mate of vessels of 3,000 GT or more on unlimited voyages. o Chief Engineer Officer or Second Engineer Officer of on vessels of 3,000 kW or more on unlimited voyages. o Master or Chief Mate on vessels of 3,000 GT or more and between 500 GT and 3,000 GT on near coastal voyages. o Chief Engineer Officer or Second Engineer Officer on vessels of 3,000 kW or more and between 750kW and 3,000 kW on near coastal voyages. o Officer in charge of a navigational watch on vessels of 500 GT or more or Officer in charge of an engineering watch on vessels of more than 750 kW. o Master or Officer in charge of navigational watch on vessels of less than 500 GT on near coastal voyages. o Master or Mate on vessels of less than 500 GT on domestic voyages. o Engineer Officer on vessels of less than 750 kW on domestic or near coastal voyages. o A degree in any maritime field with 6-years relevant experience or other degrees with 8-years continuous experience within the maritime field. o A Pilot License acceptable to the Council. Is a holder of any relevant qualification acceptable to the Council. Associate Member Should be associated with the maritime field and hold qualifications other than that of an Ordinary Member. Student Member Should be between 17 to 25 years old and pursuing a maritime-bias course. Corporate Member Open to companies/organizations within the maritime industry, other than shipowning entities. ANNUAL SUBSCRIPTION ORDINARY MEMBER LIFE MEMBER ASSOCIATE MEMBER STUDENT MEMBER CORPORATE MEMBER RM 60.00 RM 20.00 RM 1000.00 (One-time subscription) RM 100.00 RM 1000.00