MALAYSIA GREEN BUILDING COUNCIL (malaysiaGBC) APPLICATION FOR ASSOCIATE MEMBERSHIP Under malaysiaGBC Constitution Clause 4.1.7, 4.4 and 6.0 (To be completed by Applicant in BLOCK LETTERS) PHOTO Full Name : ……………………………………………………………. …………………………………………………………………………… Other Names : ……………………………………………………….. Sex : ……………………………………………………………………. Date of Birth : ………………………………………………………… Place of Birth : ………………………………………………………... FOR OFFICE USE ONLY Citizenship Status : ……………………………………………………. Date received: …………………………………………. Identity Card / Passport No : ………………………………………. Receipt No. Company Name : ……………………………………………………. ………………………………………… Business Address : ……………………………………………………. Amount Paid: ………………………………………... …………………………………………………………………………… Date acceptable to the Board: …………………………………………………………………………… ………………………………………… Position : ………………………………………………………..……… Date approved for circulation: Tel. No : …………………………………………………………………. ………………………………………… Fax No : …………………………………………………………………. Date of election: ………………………….. Mobile : …………………………………………………………….….. Email :…………………………………………………………………… To : The Honorary Secretary Malaysia Green Building Council (malaysiaGBC) CGMV, BO 1-C, Level 19, Menara 2, No. 3, Jalan Bangsar KL Eco City, 59200 Kuala Lumpur. I, ………………………………………………………………………………………………………………………………… (name in block letters) Hereby apply for Associate Membership of the Malaysia Green Building Council and declare as follows: -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- APPLICATION FORM ASSOCIATE MEMBERSHIP – REV 3.2020 1 A. Academic Qualifications acceptable to the Board 1. Academic Qualifications: a) PhD/Master/Degree/Relevant Qualifications: ……………………………………………………………………………………………………………..….. b) University/College/ Institute: ………………………………………………………………………………………………………………… c) Year of Graduation: …………………… Month ………………………….………………………….… 2. Sustainability / Green Body Membership a) Name of Sustainability / Green Body: …………………………………………………………………………………………………………………. b) Position: …………………………………………………………………………………………………………………. I hereby agree to abide by the Constitution of malaysiaGBC Signature……………………………………………………………..….. Date………………………………………………………………………. NOTE: Applicant should submit certified photocopy of testimonials, certificate and other relevant supporting documents. Application should be accompanied by entrance fee and subscription for the year. Entrance Fees: RM 500 Annual Subscription: RM 250 for year …………………………………………… NOTE: With the implementation of SST, please take note that all fees are subjected to 6% SST for malaysiaGBC membership effectively from 1 September 2018 onwards. Please take note the fees above is excluded of 6% SST. We the undersigned being Members of malaysiaGBC do, from our personal knowledge of the above applicant, propose and recommend him/her as a fit and proper person to be admitted as an Associate Member of malaysiaGBC. PROPOSER SECONDER …………………………………………………. …………………………………………….. Signature Signature ……………………………….……………….. ……………………………………………… Name (in block letters) Name (in block letters) ………………………..……………………….. ………………………………………………. malaysiaGBC Membership No. malaysiaGBC Membership No. Date ……………………………………….. NOTE: Proposer and Seconder Should Be Current Members of malaysiaGBC -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- APPLICATION FORM ASSOCIATE MEMBERSHIP – REV 3.2020 2 Payment Details Amount : RM 795.00 (inclusive of 6% SST) Payment for : Entrance Fees & Annual Subscription for the year ………………….. Payable To : Malaysia Green Building Council Account No. : 514253533659 Bank : Malayan Banking Berhad (Maybank) Payment Method : Cheque Cheque No. _______________________ Cash Bank Transfer (please attached the bank slip) -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- APPLICATION FORM ASSOCIATE MEMBERSHIP – REV 3.2020 3 .