Individual Membership Registration Form

Personal Details

I wish to apply for membership of the IKHTISAS KELAUTAN MALAYSIA (Association of Malaysia’s Maritime Professionals) as Individual. Personal details are as follows:

Full Name *

Full name according to national issued identification card or MyKAD

Date of Birth

Date of Birth according to national registration

NRIC No.

Your national issued personal identification number

Citizenship *

Job Position

Home Address (Admission Pack will be delivered here) *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Handphone No. *

Telephone No.

Fax No.

Personal Email Address *

Next of Kin

Name *

Relationship *

Telephone No *

Employer Details

Name of Employer

Address of Employer

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Professional & Academic Qualifications

Professional Qualification *

Academic Qualification *

File Upload *

Click or drag files to this area to upload. You can upload up to 2 files.

Please attach with this application a copy of page 1 of your certificate of competency (CoC) or certificate of proficiency (CoP) or Academic Degree that you hold. Only jpeg, jpg, png, pdf or docx are allowed

Agreement

Note: Successful applicants will be notified on procedure of banking in the RM50.00 Entrance Fee and appropriate Membership Fee once approved. Once payment has been made & letter of admission is released, no refund of fees paid will be entertained should the member decide to resign. Click on "Submit" button to send this form. By clicking the submit button you are agree that 'All details given are correct and up to date' and 'Agreed to be contacted by IKMAL for announcements and other related matters'. *

Agree