CHIEF EXECUTIVE OFFICER
MALAYSIA COMPETITION COMMISSION
Level 15, Menara SSM@Sentral, No.7 Jalan Stesen Sentral 5,
Kuala Lumpur Sentral, 50623 Kuala Lumpur.
Tel: 03-2273 2277 | Fax: 03- 2272 1692
For Official Use
Date received:
Ref No.:
EXEMPTION APPLICATION FORM (E1 Form)
1.
INFORMATION ON APPLICANT
Name of Applicant
Address of Applicant
Company/ Business Registration Number
* Please provide a photocopy of registration of company/ business from the Companies Commission of Malaysia (SSM)
Telephone Number
Fax Number
Email Address
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2.
INFORMATION ON PARTIES TO AGREEMENT
Name of Party to Agreement (1)
Address of Party to Agreement
Company/ Business Registration Number
* Please provide a photocopy of registration of company/ business from the Companies Commission of Malaysia (SSM)
Telephone Number
Fax Number
Email Address
Name of Party to Agreement (2)
Address of Party to Agreement
Company/ Business Registration Number
* Please provide a photocopy of registration of company/ business from the Companies Commission of Malaysia (SSM)
Telephone Number
Fax Number
Email Address
Note:
* If there are more than two (2) parties that enter into the agreement, the Applicant may
provide similar information on additional papers.
* All documents that submitted to the MyCC must be certified copies of original documents.
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3.
INFORMATION ON THE AGREEMENT
3.1 TICK (√) the form(s) the Agreement is entered into by the Parties i.e. by way of a contract
and/or decision by association and/or resolution etc.
Contract
Arrangement
Understanding
Decision by association
Others: Please specify
3.2
TICK (√) the type of the Agreement
Horizontal Agreement
Vertical Arrangement
3.3
Kindly submit a hardcopy of the Agreement with this form.
3.4
If the Agreement is not in writing, kindly provide the details of the Agreement.
3.5 Kindly specify the identified anti-competitive clause(s) in the Agreement and/or conduct(s)
that the Applicant is seeking exemption for:
3.6
TICK (√) the the status of the Agreement
Entered into and implemented
Entered into but not implemented
Has yet to be entered into
Others: Please specify
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4.
INFORMATION ON THE MARKET
4.1 Kindly specify the relevant market defined
4.2 Kindly provide a list of players in the relevant market.
5.
INFORMATION ON MARKET SHARE/ TURNOVER/ PRODUCTS
Parties to the agreement
Market Share (%)
Annual Turnover (RM)
Applicant
Party to Agreement (1)
Party to Agreement (2)
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6.
RELIEF OF LIABILITY
Reasons why the Agreement does not have the object or effect of significantly preventing,
restricting or distorting competition in the relevant market (Kindly refer to section 5 of the
Competition Act 2010). Kindly also indicate the paragraph(s) as numbered in the submission
for each argument.
a)
there are significant identifiable technological, efficiency or social benefits directly arising
from the agreement;
b)
the benefits could not reasonably have been provided by the parties to the agreement
without the agreement having the effect of preventing, restricting or distorting competition;
c)
the detrimental effect of the agreement on competition is proportionate to the benefits
provided;
d)
the agreement does not allow the enterprise concerned to eliminate competition completely
in respect of a substantial part of the goods and services.
7.
DECLARATION
I hereby declare and confirm that all information given in this Form E1 and all information
provided in documents annexed hereto are correct to the best of my knowledge and belief.
Name as per NRIC
NRIC Number
Designation
Signature
Official Stamp
Date
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