Form No. I
Application For Ordinary Membership Of The
Malaysian Rubber Exchange
1.
Name of Applicant :
Company's Name
Official Address :
Postcode :
State :
- Select a State -
Johore
Kedah
Kelantan
Malacca
Negeri Sembilan
Pahang
Perak
Perlis
Pulau Pinang
Sabah
Sarawak
Selangor
Terengganu
W.P. Kuala Lumpur
W.P. Labuan
W.P. Putrajaya
Tel No :
Fax No :
E-mail :
2.
Membership Classification Applied For :
Producer
Dealer
Broker
User
3.
(a) Constitution of Business :
Sole Proprietorship
Partnership
Private Limited Company
Public Limited Company
(b) Date of Incorporation/Registration :
dd/mm/yyyy
(c) Country of Incorporation/Registration :
4.
(a)
Nature of business in
rubber
rubber product
being undertaken
to be undertaken
:
Specify main activity of company
(b) Number of years in rubber/rubber products business:
0
1
2
3
4
5
6
7
8
9
10
11-15
16-20
21-25
>25
(c) Type of licence(s)
issued
being applied for
under Regulation 6 of the Malaysian Rubber Board (Licensing) Regulations, 1997 :
A1
A2
B
C
D
(d) Type of certificate(s)
issued
being applied for
under Sub-regulation 37(1) of the Malaysian Rubber Board (Licensing) Regulations 1997 :
CC
DD
EE
5.
Paid-up Capital
(a) Amount : RM
(b) Ownership structure
(i)
Malaysian
Bumiputra
RM
%
Non-Bumiputra
RM
%
(ii)
Non-Malaysian
Nationality
RM
%
RM
%
RM
%
6.
Bank Guarantee (if applicable)
Amount :
RM
Banker's Name :
Address :
7.
Particulars of Directors/Partners and Principal Officers
*
:
Directors/Partners
Principal Officers
*
as at date of application
8.
Trade Association/Affiliation (if any):
9.
Bank Confidential Report from :
Name of Bank:
Address :
Applicant's Name :
Designation :
Date :
11/22/2008
By submitting this form, you indicate that you agree to forward your application to the Malaysian Rubber Exchange for processing to become a member.
