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Pertubuhan Juruukur Malaysia: The Institution of Surveyors, Malaysia

This document is an application form for election as a member of the Institution of Surveyors Malaysia (ISM). It requests information such as the applicant's personal details, qualifications, employment, proposer/seconder details, and declaration. The applicant needs to provide academic qualifications, professional qualifications/training, employment details certified by their employer, and be proposed and seconded by existing ISM members. Upon completing the form and attaching supporting documents, it will be processed by the ISM secretariat.

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Zulkhazmi Azam
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70 views

Pertubuhan Juruukur Malaysia: The Institution of Surveyors, Malaysia

This document is an application form for election as a member of the Institution of Surveyors Malaysia (ISM). It requests information such as the applicant's personal details, qualifications, employment, proposer/seconder details, and declaration. The applicant needs to provide academic qualifications, professional qualifications/training, employment details certified by their employer, and be proposed and seconded by existing ISM members. Upon completing the form and attaching supporting documents, it will be processed by the ISM secretariat.

Uploaded by

Zulkhazmi Azam
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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FORM A2

PERTUBUHAN JURUUKUR MALAYSIA


The Institution of Surveyors, Malaysia
3rd Floor, Bangunan Juruukur, 64-66, Jalan 52/4, 46200 Petaling Jaya, Selangor
Tel: 03 - 79551773/79569728/79548358
Fax: 03-7955 0253
Website : www.ism.org.my
Email: [email protected]

APPLICATION FOR ELECTION AS A MEMBER


Divisions:
Geomatic & Land Surveying / Quantity Surveying / Property Consultancy & Valuation Surveying / Building Surveying

Full Name

: __________________________________________________

Other Names

: ________________________________ Gender: ___________

Date & Place of Birth


Nationality Status

: __________________________________________________

Please affix your photograph


here. An additional
photograph is to be enclosed
with this application

: __________________________________________________

Identity Card New

: ________________________________ Old : ___________

Passport No

FOR OFFICE USE ONLY

: ______________________________

Regular Business Address

: __________________________________________________

_____________________________________________________________________

Date Received

Date Referred To
:
Divisional Committee
Date

Office No

: ____________________________ Postcode : ______________________

Mobile No

: ____________________________ Fax No : ______________________

Date of Admission

Date Of Notification

: __________________________________________________________

Membership No

Email

House Address

Recommended

Signature of Secretary :

: ______________________________________________________

_____________________________________________________________________
_

Tel No :

To:

______________________

Date:

Secretary General
The Institution of Surveyors Malaysia

I, ________________________________________________________________________
(NAME IN BLOCK LETTERS)
hereby apply to be a Member of The Institution of Surveyors Malaysia and declare as follow:
A.

QUALIFICATION
1.

ACADEMIC QUALIFICATION

a)

Degree : _______________________________________________________________________________________________

b)

University / College / Institute: _____________________________________________________________________________

c)

Year of Graduation : _____________________________________________________________________________________

d)

Diploma : ______________________________________________________________________________________________

e)

University / College / Institute: _____________________________________________________________________________

f)

Year of Graduation : _____________________________________________________________________________________

2. PROFESSIONAL QUALIFICATIONS AND TRAINING


a)

i. Other Professional Qualifications: ____________________________________________________________________________


ii. Practical Experiences: ____________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________

b)

Year of Passing ISM Professional Examination (Final / Direct Final) : _________________________________________________


OR

c)

Any Other Equivalent Examination: ____________________________________________________________________________


________________________________________________________________________________________________________

B.

EMPLOYMENT DECLARATION
The declaration on this page must be signed by the Principal or Partner in the candidates firm. Where the candidate is employed in
the public service in a branch office of by a large undertaking, the signature of the head, or his / her authorized deputy, of the
technical department in which the candidate is engaged must be obtained.
a)

The candidate is employed in the capacity of: ___________________________________________________________


________________________________________________________________________________________________

b)

The candidate is engaged on the following duties: ________________________________________________________


________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

c)

Name and qualifications of the person directly responsible for the candidates training
________________________________________________________________________________________________

d)

Signature of Principal or Head of Department with qualifications, degrees, etc.


________________________________________________________________________________________________
Name of Employer in BLOCK LETTERS: _______________________________________________________________

C.

PROPOSER AND SECONDERS


We, the undersigned being Fellow / Member of ISM do, from our personal knowledge of the above applicant, propose and
recommended him / her as a fit and proper person to be admitted as a full member of The Institution.
PROPOSER

SECONDER

SECONDER

Name
(in block letters)
Address:

Signature
Date:
NOTE:

D.

Signature of the members of ISM (of whom one must be Fellow)OR of two members of the Council whom the President
must be one.
APPLICANTS DECLARATION

I hereby certify that the above particulars are correct.

Signature :
Date

___________________________________________

Note
:
Certified photostate copies of IC, testimonials, certificates and other relevant documents in support
of the application must be submitted
* Delete where appropriate

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