APPLICATION FOR REGISTRATION AS A GRADUATE ENGINEER (To be completed by the Applicant in BLOCK LETTERS)

Transcription

1 FORM A1 REGISTRATION OF ENGINEERS ACT 1967 REGISTRATION OF ENGINEERS REGULATIONS 1990 Applicant s current passprt size pht APPLICATION FOR REGISTRATION AS A GRADUATE ENGINEER (T be cmpleted by the Applicant in BLOCK LETTERS) SECTION A (t be filled in by All) Name:... Gender: Male Date f Birth:.. Female Natinality: Place f Birth:. Identificatin Card N.:... Address in Malaysia (if any): Tel. N.:. Mbile Phne N.:... Fax N.:... Pstal Address (if different frm abve): Address: Qualificatins:..... SECTION B (t be filled in by Nn-Malaysian) Passprt N.:. Date f Issue: Cuntry f Birth:.. Place f Issue:. Date f Expiry: Natinality:. Address in Cuntry f Origin:.... I have been a Permanent Resident f Malaysia since... Identificatin Card N. :.. PENALTY Sectin 24(a) f the Registratin f Engineers Act 1967: "Any persn, sle prprietrship, partnership r bdy crprate wh prcures r attempts t prcure registratin r a certificate f registratin under this Act by knwingly making r prducing r causing t be made r prduced any false r fraudulent declaratin, certificate, applicatin r representatin whether in writing r therwise, shall be guilty f an ffence and shall, n cnvictin, be liable t a fine nt exceeding fifty thusand ringgit, r t imprisnment fr a term nt exceeding three years, r t bth.". ( ) - 1 -

2 FORM A1 DECLARATION TO BE SIGNED BY THE APPLICANT a) I, the undersigned, apply fr registratin as a Graduate Engineer and if I am registered, I agree t abide by i. The Registratin f Engineers Act 1967 and The Registratin f Engineers Regulatins 1990; and ii. Ntificatins and Circulars issued by the Bard f Engineers Malaysia. b) I hereby authrize the Bard f Engineers Malaysia t seek clarificatin n any infrmatin submitted in any manner and by any means as it deems fit and prper. Date:. (Signature f Applicant) Nte: Applicant t submit certified cpies (by a Prfessinal Engineer recgnized by the Bard f Engineers Malaysia) f the fllwing: Degree scrll and fficial transcripts Diplma scrll and fficial transcripts (if any) Identificatin Card Permanent Resident and/r Passprt (fr Nn-Malaysian) The applicatin shall be accmpanied with a nn-refundable prcessing fee fr the amunt f RM50.00 in the frm f mney rder, pstal rder, bank draft, cheque r any ther frm as determined by the Bard, made payable t the Bard f Engineers Malaysia. Fr Office Use Only Start Date:... Applicatin Status:. Applicatin Date:... Current Status:... Rejectin Date:.. Circulatin Date:.... Received Date:... Apprval Date:..... Nte Date:.. List Status..... Suffix: ( ) - 2 -

3 APPENDIX - A Academic Qualificatins I cnfirm that the infrmatin prvided in this frm is true and crrect and that any supprting dcumentatin submitted with my applicatin is genuine. Please tick ( ) in the apprpriate bx. 1. Certificate r Diplma f Higher Educatin: Name f the Certificate/Diplma/Matriculatin/: /Fundatin Year/ A Level... University/Cllege: Year f Study: Frm.... T First Engineering Degree: a) Name/Title f Degree / Qualificatin: BEng (Hns) BEng BSc MEng MEng (Hns) b) Engineering Curse:.... c) University & Campus:.... d) *(i) Perid f Study: 3 years 4 years 5 years (ii) Year f Study: Frm.. t.. (iii) Mde f Study: Full time *(i) Full residential (ii) Sandwich Part Time / SPACE Twinning Prgramme *(i) Prgramme 2+1 (ii) Prgramme 1+2 (iii) (iii) Prgramme 3+0 (iv) 3 4 year prgramme. (in Malaysia/utside Malaysia) (v) Others, please specify. Distance Learning *(i) Crrespndence Curse (ii) Vide Cnferencing Franchised Prgramme (i) Name f Cllege:.. (ii) Franchise University:. 3. Other Qualificatin (if any)..

4 APPENDIX - B BRANCH OF ENGINEERING Listed belw are branches f engineering registered by the Bard f Engineers Malaysia. Please tick ( ) in the apprpriate branch f engineering in accrdance with yur degree scrll. Example: If yur academic qualificatin is BEng in Civil Engineering, please tick Civil. Civil Mechanical Electrical Electrnic Chemical Mining Aernautical Mineral Prcessing Agriculture Industrial Prductin Marine Instrumentatin & Cntrl Material Petrleum Cmputer Structural Envirnmental Others (please specify)..

5 APPLICATION FOR REGISTRATION AS A GRADUATE ENGINEER CHECKLIST Tick ( ) if it is applicable and has been fulfilled. Crss ( X ) if it is nt applicable. Applicant Office Use 1. A prcessing fee f RM Frm A1 has been duly filled and signed. 3. Cpy f Identificatin Card. (Crss with remarks FOR BEM USE ONLY ) (Sftcpy have been upladed) 4. Cpy f Permanent Resident Card and/r Passprt (Nn-Malaysian) 5. Cpy f Degree scrll and full fficial transcripts (first year t final year).(sftcpy have been upladed) 6. Cpy f Diplma scrll and fficial transcript (if any) (Sftcpy have been upladed) 7. The degree is accredited by EAC Malaysia r by a Prfessinal bdy wh is a signatry f Washingtn Accrd r equivalent qualificatin recgnised by BEM. Remarks: I cnfirm that I have cmpleted the abve and fulfils BEM requirements. Fr Office Use Only Signature f Officer-in-charge Bard f Engineers Malaysia Signature f Applicant.. Date: Date: ( )

6 Pusat Kepimpinan Akademik UTM (UTMLead) BORANG PEMBAYARAN YURAN PENDAFTARAN LEMBAGA JURUTERA MALAYSIA (BEM) Nama: N. Kad Pengenalan: Fakulti: Tarikh: Tandatangan *Sila serahkan brang ini semasa membuat pembayaran di kaunter Pejabat Bendahari. Untuk Kegunaan Pejabat Bendahari Diterima leh: Tandatangan & Cp Tarikh: *Nta: Tarikh bayaran yuran BEM di kaunter Pejabat Bendahari adalah pada 29 Oktber 19 Nvember 2017 sahaja.