ICA 10
www.mida.gov.my
(09.03.2012)
Malaysian Investment
Development Authority
APPLICATION FOR CONFIRMATION LETTER FOR A COMPANY EXEMPTED
FROM MANUFACTURING LICENCE UNDER
THE INDUSTRIAL CO-ORDINATION ACT 1975 (AMENDMENT)
1.
Name of company : ___________________________________________________
Date of Incorporation: ______________Company Registration No: _______________
Income Tax Ref. No:________________ Income Tax Branch Office: _____________
2.
Registered Address : __________________________________________________
___________________________________________________________________
___________________________________________________________________
3.
Telephone no. ________________________________________________________
Fax: ___________________________
E-Mail : __________________________________
4.
Managing Director / General Manager :
________________________________
5.
Factory Location: _____________________________________________________
___________________________________________________________________
___________________________________________________________________
6.
No. of Full Time Employment: ___________________________________________
7.
Total Project Cost:
8.
Paid-up Capital / Shareholders’ Fund: _____________________________________
9.
Equity
10.
__________________________________________________
Bumiputera
:
____________________ %
Non-Bumiputera
:
____________________ %
Foreign
:
____________________ %
Product: ____________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
ICA 10
11.
Incentive (if any): _____________________________________________________
___________________________________________________________________
12.
Estimated Production Capacity for the first 3 Years in operation (Quantity / value):
___________
13.
Market:
Domestic
:
____________ %
Export
:
____________ %
_________________________________________________________________________
14. DECLARATION
__________________________________________________________________
I,
(i)
, the Managing Director of
hereby declare that to the best of my knowledge, the particulars furnished in this application are
true.
(ii)* have engaged/is planning to engage the services of the following consultant for my application :
Company Name
:
Address
:
Contact Person
:
Designation
:
Telephone no.
:
Fax no.
:
E-mail
:
I take full responsibility for all information submitted by the consultant(s).
Date
(Signature)
*Please complete this section if the company has engaged/is planning to engage the services of
consultant(s) to act on behalf of the company. Please provide information on a separate sheet of
paper if space is insufficient