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Malaysian Institude of Corporate Governance

(Institude Tadbir Urus Korporat Malaysia)

CORPORATE MEMBERSHIP APPLICATION FOR THE YEAR OF 2017

SUBSCRIPTION FEE : RM2,120/YEAR (INCLUSIVE OF GST)

(A) COMPANY / ORGANISATION
Name *
Registration No. * Date of Registration *
Business Address *
Postcode * State * Country *
Tel No. * Fax No. *
Website * Email *
Statute under which the company / organisation is registered (e.g. Companies Act 1965)
Main Objectives / Principal Activities
(B) KEY CONTACT ON MEMBERSHIP MATTERS (This section must be completed)
Name of Representative * Email *
Designation * Department *
Direct Line * Direct Fax * Mobile No. *
Name of Representative (Alternate) * Email *
Designation * Department *
Direct Line * Direct Fax * Mobile No. *
(C) KEY CONTACT ON EVENTS (This section must be completed)
Name * Email *
Designation * Department *
Direct Line * Direct Fax * Mobile No. *
(D) PAYMENT METHOD

Crossed cheques must be payable to MALAYSIAN INSTITUTE OF CORPORATE GOVERNANCE

For Interbank Giro (IGB) or direct payment, please email copy of transaction slip to info@micg.org.my

Name of Bank : Malayan Banking Berhad
Account No. : 5141 6915 2428
Swift Code : MBB EMYKL
Bank’s Address : 50-52, Jalan Sultan (52/4), 46200 Petaling Jaya, Selangor
(E) WE DECLARE that :
  • All information contained in this application form are true and correct.
  • This is an application for membership. No reference of affiliation with MICG will be made until approved and accepted.
  • If accepted, we agree to abide by the Memorandum and Articles of Association and Rules / Codes of Malaysian Institute of Corporate Governance.
Name of Authorised Person * Designation * Date *
(F) CHECKLIST FOR APPLICATION
Please summit Certified True Copy of Memorandum and Articles of Association to MICG.
Note: This is the online application. No signature is required.
The Board of Governors shall have the full power and discretion as to the admission of any corporation to be a member of the Institute and may reject any application for membership without assigning any reasons hereto. [Refer MICG AA Cl. 8]
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