Membership Application Form Field mark with an (*) are required for both applicant categories. "INDIVIDUAL APPLICANT" Select membership category: Registration Fee @ RM50.00 Annual Membership RM 250.00Lifetime Membership RM 1,000.00 Name (Full name as in NRIC) NRIC No. Professional Designation GenderMaleFemale Date of Birth Nationality "CORPORATE APPLICANT" Company Name Address Postal Code State ROB/ ROC/ ROS No. Office Direct Phone No. Mobile No. Official Company E-mail Website Main Activities of Company/ Organization (Please state): Nature of Constitution Sole ProprietorshipPartnershipPrivate Limited CompanyPublic Limited CompanyOthers Others (Please specify): Are you the First Applicant of your Company?YesNo Select membership category: I'm the first applicant of the company Registration Fee @ RM50.00 Please SelectAnnual Membership RM 250.00Lifetime Membership RM 1,000.00 I'm not the first applicant of the company Registration Fee @ RM50.00 Please SelectAnnual Membership RM 250.00Lifetime Membership RM 800.00 Name of Representative: Designation: Mobile No.: Email Address: * PAYMENT DETAILS Payment method (in Ringgit Malaysia MYR) CashOnline TransferCheque Payment shall be made payable to: BANK NAME: MAYBANK BERHAD ACCOUNT NAME: PERSATUAN PENGUSAHA PENDIDIKAN SWASTA MALAYSIA ACCOUNT NO: 5571 3925 8922 * DECLARATION 1. I am not an undischarged bankrupt. 2. I have not convicted whether within or outside Malaysia of any offence: (a) in connection with the promotion, formation or management of a corporation. (b) involving fraud or dishonesty punishable on conviction with imprisonment for three months or more. 3. I declare that the information stated in the application and the accompanying information are true and correct to the best of our knowledge. Check to state you have read and agree our Terms and Conditions.