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ICA 10
(18.09.2014)
Company Name
Mailing Address
Tel. No.
Fax No.
Website
Licence/Incentives
Approved By Other
Government Agencies
Products / Activities
Source of Technology
Duty/Tax exemption
Exemption letter
Foreign labours
Subsidies on utilities
Others (Please specify):
___________________________________
Value
a) Land
(RM)
b) Factory
(RM)
c) Plant/Machinery
(RM)
ICA 10
d) Other Equipment
(RM)
Total
(RM)
2. Pre-operational Expenditure
3. Working Capital
(Current Assets - Current Liabilities)
(RM)
(RM)
(RM)
Section C : Financing
5. Capital Structure :
(RM)
1. Authorised Capital
2. Shareholders Fund
(a) Paid Up Capital
(i) Malaysian Individuals
Bumiputera
Non-Bumiputera
(ii) Company Incorporated in Malaysia*
Bumiputera
(%)
RM
Non
-Bumiputera
(%)
i)
ii)
6. Loan
(RM)
a) Domestic
b) Foreign (specify country of origin)
Total of (a) and (b)
(RM)
a)
b)
Total of (a) and (b)
8. Total Financing
(Paid Up Capital + Reserves + Loan + Other Sources)
Section D : Employment
Section E: Sales
2
Foreign (specify
country) (%)
ICA 10
Section E : Sales
10. Proposed Export (%):
11. Product Pricing Details :
% of ex-factory price for each product
Item
Product 1
Product 2
Product 3
100%
100%
100%
b.
c.
The layout plan for the machinery and equipment in the approved manufacturers premise and to
indicate where the machinery and equipment will be located.
d.
Sales Tax Licence (CJ2 or JKED No.3) or certificate of exemption from Sales Tax Licence (JKED No. 3)
from Customs (if applicable).
e.
Business Premise Licence from the Local Authority.
f.
Latest printout of SSM Company Profile and Business Profile from the Companies Commission of
Malaysia (SSM).
g.
Memorandum of Association (M&A).
Section G : Declaration
I, .., the Managing Director of
i.
ii.
iii.
hereby declare that to the best of my knowledge, the particulars furnished in this application are true.
hereby furnished all the documents required as stated in Section F of this form;
agree that the information pertaining to my company i.e. company name, nature of business, contact
details and status of manufacturing licenses; may be published by MIDA;
Date
(Signature)
Companys Stamp/Seal
ICA 10
APPENDIX I
Section D : Employment
Please note that the information is required to enable the government to undertake the appropriate
manpower planning to meet the specific manpower needs of companies proposing to establish
projects in Malaysia.
1.
2.
Engineering/Technical
qualifications
(b)
Science qualifications
(c)
Other qualifications /
experience
Foreign
National
Malaysian
Foreign
National
Malaysian
Foreign
National
Malaysian
Foreign
National
Note:
*
include wages, salaries, bonuses, social insurance contribution and all employee benefits.
If there is more than one factory location, please provide the same information on a separate sheet of paper.
**
Machine operators and assemblers are those involved in the production/assembly line who receive mainly on-the-job training
for a period between 3 to 6 months,e.g. production operators.
ICA 10
1.
Percentage of science and technical staff having degrees or diplomas with a minimum of
5 years experience (of the total workforce)
3. In addition to the full-time employees as mentioned in the above tables, please provide the
number of workers which are outsourced (not under the companys payroll)
______ %
______
______