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Malaysian Institude of Corporate Governance

(Institude Tadbir Urus Korporat Malaysia)

ORDINARY MEMBERSHIP APPLICATION FOR THE YEAR OF 2017

SUBSCRIPTION FEE : RM318/YEAR (INCLUSIVE OF GST)

(A) PERSONAL DETAILS
Title (Dr / Mr / Ms /Mdm / Others) *
Full Name (as per NRIC / Passport) *
NRIC / Passport No. * Nationality * Race *
Residential Address *
Postcode * State * Country *
Home Phone No. Mobile No. * Email *
College / University
Highest Qualification Year
Membership / Affiliation(s) Member Since
(B) CURRENT EMPLOYMENT (This section must be completed)
Employer *
Type of Business *
Occupation * Since *
Working Experience (in years) * Training Experience (in years) *
Business Address *
Postcode * State * Country *
Phone No. * Fax No. * Email *
(C) What areas of corporate governance are you specifically interested in ?
(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) I 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, I agree to abide by the Memorandum and Articles of Association and Rules / Codes of Malaysian Institute of Corporate Governance.
Applicant's Name: Date:
Please attach:


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Passport Size Photo



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Photocopy of IC / Passport, Certified True Copies of Qualifications, Membership, Affiliations



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Letter from Employer / HR Department stating:

  • Your Designation
  • Your Employment Job Function
  • Years on the Job / Working Experience

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 person qualified 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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