Through Agent Application Form (Complete)

NO.
DOKUMEN
TARIKH KUATKUASA
MUKA SURAT
PK.(O).KPK.PSA.02 (L1) Pin.1

11 APRIL 2014
1 daripada 4
MALAYSIA MY SECOND HOME (MM2H) CENTRE

Ministry of Tourism and Culture Malaysia
MALAYSIA MY SECOND HOME (MM2H) PROGRAMME
CHECKLIST FOR APPLICATION THROUGH MM2H LICENSED COMPANY
For official use
Please tick ()
For agent use only

Please tick ()
1.
Letter of Application (by the applicant);

o
Include information on personal background, intention to join the MM2H Programme, if

joining as a single or with family and briefly explain how applicant will support his/her
stay in Malaysia (financial capabilities)
2.
3.
A copy of resume by the main applicant which includes the following information:
o
Academic qualification
Working experience
Skills or expertise acquired
One (1) copy of MM2H Application Form (downloadable from MM2H website)
Note: Form has to be completed individually for main applicant and all dependents.
4.
Three (3) copies of IM.12 Form Social Visit Pass

o
One (1) original copy (form is downloadable from MM2H website); and
Two (2) Photostat copies.
Note: Form has to be completed individually for main applicant and all dependents.
5.
Four (4) coloured passport sized photographs (3.5 x 5.0 cm)
6.
Copy of Passport/ Travel documents

o
One (1) copy with certification on personal particulars page (all pages)
Two (2) copies of personal particulars page
Note : Copy of the previous passport is required if main applicant/dependent(s) has

renewed passport within the last 12 months
7.
Personal Bond
o
Personal Bond is to be submitted for main applicant only
Must be completed and signed by Malaysia who is one of the Board of Directors/
Shareholders/ managing Director/ manager from the appointed MM2H licensed
company.
8.
Letter of Good Conduct from main applicants relevant government agency

1
NO. DOKUMEN
TARIKH KUATKUASA
MUKA SURAT

11 APRIL 2014
2 daripada 4

For official use
Please tick ()
For agent use only

Please tick ()
9.
Self declaration on main applicants/ dependents health conditions Form RB I

(downloadable from MM2H website)
10.
Certified copy of Marriage Certificate (if accompanied by spouse)
11.
Certified copy of Birth Certificate/ legal documents (if accompanied by children/ adopted
children/ stepchildren/ parents);
o
Letter of Confirmation from Medical Specialist/ General Practitioner (if accompanied by

children aged 21 years and above with disabilities).
Statutory Declaration by main applicant to bear all expenses and financial requirements
during stay in Malaysia for dependents.
Legal custody documents (for sole custody) and letter of authorization from other parent
(for divorced parents accompanied by children)
12.
Certified Copy(s) of latest 3 months bank statement/ other related financial document(s) to
indicate the financial capability to support stay in Malaysia;
13.
Certified copies of latest 3 months payslip/ income statement (if employed/pension slip)
o
The MM2H Centre would like to inform that effective 12 July 2012, all MM2H
applications must submit bank account statements that shows the latest 3 months
deposit for monthly income (either from salary/ rental/ interest earned/ shares) or
government pensions into the applicants bank accounts
14.
Financial Authorization Letter; to verify the financial documents with the relevant financial
Institutions (downloadable from MM2H website)
NO. DOKUMEN
TARIKH KUATKUASA
MUKA SURAT

11 APRIL 2014
3 daripada 4

IMPORTANT NOTES:
o All copies must be certified TRUE COPIES OF ORIGINAL DOCUMNTS by EMBASSY/ HIGH COMMISSION/
NOTARY PUBLIC and COMMISSIONER OF OATHS REGISTERED IN MALAYSIA/ GOVERNMENT OFFICIAL.
o Where original documents are not in ENGLISH, translation must be done by a qualified translator and
CERTIFIED.
o Dependent(s) refer to:
o Spouse
o Children aged below 21 years (maximum 6 months before reaching 21 years old at time of
application) and not married; and
o Parent(s) of main applicant aged 60 years and above.
o Application to include parent(s) as dependents is to be submitted AFTER main applicants application has
been approved.
o All documents enclosed with the present application become the property of the Malaysia My Second Home
(MM2H) Centre and will not be returned.
For APPROVED Participants:
o For dependents added after application has been approved, Personal Bond has to be submitted for each
dependent.
o The Personal Bond Form must be stamped (RM10.00) by the Stamping Office in Inland Revenue Board of
Malaysia
o The amount chargeable is according to Country of Origin of the applicant/ participant. Please refer to Rate of
Security/ Personal Bond by Country.
NO. DOKUMEN
TARIKH KUATKUASA
MUKA SURAT
PK.O).KPK.PSA.02(L1)Pin.1
11 APRIL 2014
4 daripada 4

APPLICATION CHECKLIST FOR MALAYSIA MY SECOND HOME (MM2H) PROGRAMME
- REQUIRED DOCUMENTS FROM APPOINTED MM2H LICENSED COMPANY
For official use
Please tick ()
For agent use only

Please tick ()
1.
Surat iringan daripada Syarikat Berlesen MM2H;

Cover letter from MM2H licensed company
Note : Licensed Company is required to summarize all financial information provided by
applicant in the cover letter
2.
Salinan lessen syarikat berlesen MM2H yang masih sah tempoh

One (1) copy of companys Mm2H license which is still valid
3.
Surat pengesahan wakil sebagai pekerja di bawah Syarikat Berlesen MM2H

Letter of confirmation on employment of representative under the MM2H Licensed Company
o
Submissions of application by employees of the MM2H Licensed Company other than

Managing Director/ Manager has to be included with the above letter confirming
employment of that person.
4.
Salinan kad pengenalan Lembaga Pengarah/ Pemegang Saham/ Pengarah Urusan/ Pengurus
yang menandatangani Bon Peribadi.
One (1) copy of the MyKad of Board of Director/ Shareholder/ Managing Director/ Manager
who signed the Personal Bond.
5.
Borang kenyataan Penaja (perlu dilengkapkan oleh syarikat berlesen MM2H)

Sponsor Declaration Form (must be completed by MM2H licensed company)
6.
Surat pengesahan daripada Bahagian Pelesenan Pelancongan, Kementerian Pelancongan

Dan Kebudayan Malaysia sekiranya tidak dapat mengemukakan lessen syarikat (jika syarikat
masih dalam permohonan pembaharuan lesen atau perubahan syarat lesen).
Letter of Confirmation from Tourism Licensing Division, Ministry of Tourism and Culture
Malaysia if the MM2H license is not available (due to renewal or change of companys
particulars)
o
It is important that the appointed MM2H licensed company advises the client to fill out all
the sections in the application form and include all relevant documents, as incomplete
documentations/ false information will result in the application being rejected.
NO. DOKUMEN
TARIKH KUATKUASA
11 APRIL 2014
MUKA SURAT
1 daripada 5
FOR INDIVIDUAL APPLICANT / SPOUSE (THROUGH MM2H LICENSED COMPANY) v1.2
MINISTRY OF TOURISM AND CULTURE MALAYSIA

Malaysia My Second Home Centre
Telephone: +603 88917424
Fax: +603 88917414
APPLICATION FORM FOR THE MALAYSIA MY SECOND HOME PROGRAMME

A. GENERAL
Passport-sized
Photograph of
Applicant (coloured)
(3.5 x 5.0 cm)
3 pieces
Please tick for applied category:

50 Years And Above
Below 50 Years
Please tick if applicant is accompanied by

Spouse
Children
Please tick location of stay

Peninsular Malaysia
Sabah
Sarawak
For the age category 50 years and above only, please specify preferred financial requirement (if application is
approved):
Fixed Deposit of RM150,000
Monthly government pension of RM10,000
B. PARTICULARS OF APPLICANT
1.
Full Name (Capital Letters)
2.
Please tick ()
3.
Marital Status [Please tick ()]
Gender
Male
Ex-Malaysian
Malaysian I/C :
Single
Married
Other
4.
Place of Birth (Country)
5.
Date of Birth (dd/mm/yyyy)
6.
Nationality
Female
Divorced
Widow/ Widower
Please Specify:
NO. DOKUMEN
TARIKH KUATKUASA
11 APRIL 2014
MUKA SURAT
2 daripada 5

7.
Passport Number
8.
Date of Expiry (dd/mm/yyyy)
9.
Permanent Address
10.
Mailing Address
11.
E-mail Address (if any)
Country Code
12.
I)
Telephone Number
Area Code
Number
1)
2)
If currently employed (Q13 Q16):
13.
Current Employment
14.
Income (Per Annum)
15.
Current Employer/
Organisation
16.
Employers Address
NO. DOKUMEN
TARIKH KUATKUASA
11 APRIL 2014
MUKA SURAT
3 daripada 5

II) If retired (Q17 20):
17.
Last employment
18.
Pension Received
(Per Annum) (if any)
19.
Last Employer/ Organisation
20.
Address of Last Employer/

Organisation
21.
Working Experience
No.
Position
Organisation
Year
1.
2.
3.
4.
5.
Applicants Signature
Date
Note: This form is to be submitted together with documents / information as per listed in Appendix A.
It is compulsory to be completed by applicant.
NO. DOKUMEN
TARIKH KUATKUASA
11 APRIL 2014
MUKA SURAT
4 daripada 5
C. DECLARATION BY DIRECTOR OF MM2H LICENSED COMPANY

I
, NRIC No
, Designation
, from company
agree that:
1. All information given in the application form and the attached supporting documents are genuinely
correct and true; and
2. that any false information given by the applicant / MM2H Licensed Company will result in the Social
Visit Pass issued to the applicant/ dependents under this Programme cancelled without further notice
and action taken upon the Licensed Company as deemed necessary by the Ministry of Tourism and
Culture Malaysia.
Dated this (day)
of (date)
in the month of
of the year
at
(address)
in the State of
Country
Date:
Signature of the above named:
Signed and executed by the above named in my presence:

Signature of Witness
Full name of Witness
Nationality
Passport/ MyKad Number :

Date
NO. DOKUMEN
TARIKH KUATKUASA
11 APRIL 2014
MUKA SURAT
5 daripada 5
* For office use only:
Individual
With wife
[Number of wives :
person(s)]
With children
[Number of children :
person(s)]
Additional Information :
* IMPORTANT:
o
Submission of application by third parties for the MM2H Programme is only authorised to MM2H Licensed
Agents. A list of registered MM2H licensed agents is available on the LICENSING page of the MM2H
Centre website at http://www.mm2h.gov.my.
NO. DOKUMEN
TARIKH KUATKUASA
MUKA SURAT

11 APRIL 2014
1 daripada 2
FOR CHILDREN BELOW 21 YEARS v1.2
MINISTRY OF TOURISM AND CULTURE MALAYSIA

Telephone: +603 88917424
Fax: +603 88917414
APPLICATION FORM FOR THE MALAYSIA MY SECOND HOME PROGRAMME
Passport-sized
Photograph of
Applicant (coloured)
(3.5 x 5.0 cm)
A. PARTICULARS OF APPLICANT
1.
Full Name (Capital Letters)
2.
Please tick ()
3.
Place of Birth (Country)
4.
Date of Birth (dd/mm/yyyy)
5.
Nationality
6.
Passport Number
7.
Date of Expiry (dd/mm/yyyy)
8.
Please tick ()
9.
Student Pass Number (if any)
10.
School/ College/ University
Gender
Student Pass
Male
Female
Yes
No
(if any)
NO. DOKUMEN
TARIKH KUATKUASA
MUKA SURAT

11 APRIL 2014
2 daripada 2
FOR CHILDREN BELOW 21 YEARS v1.2

11.
Field of Study (if any)
12.
Mailing Address
Country
Code
13.
Telephone Number
Applicant Signature
Area Code
Number
1)
2)
Date
Note: This form is to be submitted together with the main/ principal application.
LAMPIRAN 9
JABATAN IMIGRESEN MALAYSIA

BORANG PERMOHONAN PAS LAWATAN
VISIT PASS APPLICATION FORM
PERATURAN-PERATURAN IMIGRESEN, 1963 [Peraturan 11(12) dan 11(15)]
IM. 12 - Pin. 1/97

*Jenis Pas
Type of Pass
Iktisas
Sosial
Professional
Social
Berniaga
Business
Baru
New
Lanjutan
Extension
*Jenis Permohonan
Type of Application
Kerja Sementara
Temporary Employment
Gambar Pemohon
Photograph Of
Applicant
(3.5 cm x 5.0 cm)
A. MAKLUMAT PEMOHON
PARTICULARS OF APPLICANT
1.
Nama Penuh (Huruf Besar)

Full Name (Capital Letter)
2. *Jantina
Gender
Lelaki
Perempuan
Male
Female
3. Tempat/Negara Lahir
Place/Country of Birth
4. **Tarikh Lahir
Date of Birth
5. Warganegara
Nationality
hari
day
bulan
month
tahun
year
B. MAKLUMAT PASPORT PERJALANAN / DOKUMEN PERJALANAN

PARTICULARS OF PASSPORT / TRAVEL DOCUMENT
6. Jenis Dokumen Perjalanan
Type of Travel Document
7. Nombor
Number
8. Tempat / Negara Dikeluarkan

Place / Country of Issue
9. **Sah Sehingga
Valid Until
hari
day
bulan
month
C. MAKLUMAT PENGANJUR DI MALAYSI A

PARTICULARS OF SPONSOR IN MALAYSIA
10. Nama Penuh (Huruf Besar)
Full Name (Capital Letter)
11. No. Kad Pengenalan
NRIC
12. No. Telefon

Telephone No.
13. Alamat
Address
Negeri
State
D. KEPERLUAN VISA
VISA REQUIREMENT
14. *Adakah Visa Diperlukan
Visa Requirement
15. *Jenis Visa
Type of Visa
Ya
Yes
Tidak
No
Sekali Perjalanan
Single Entry
Tarikh
Date
Berulangkali Perjalanan
Multiple Entry
Tandatangan Pemohon / Penganjur
Signature of Applicant / Sponsor
Borang ini hendaklah ditaip. Tandakan (x) dalam petak yang berkenaan.
This form should be typed. Mark (x) in the appropriate box
** Format Tarikh 99/99/9999

Date Format DD/MM/YYYY
tahun
year
NO. DOKUMEN
TARIKH KUATKUASA
MUKA SURAT

11 APRIL 2014
1 daripada 3
BORANG RB I
RB I Form
MEDICAL REPORT
FOR MALAYSIA MY SECOND HOME PROGRAMME
PERINGATAN
Reminder
BAHAGIAN II DAN II HENDAKLAH DIISI OLEH PEMOHON YANG BERKENAAN
Part I and II are to be completed by the applicant
1.
BAHAGIAN I :
Part I :
a)
2.
BUTIR-BUTIR PERIBADI PEMOHON

Personal Particulars of Applicant
NAMA PENUH :
Full name:
(DALAM HURUF BESAR / IN CAPITAL LETTERS)
b)
NAMA LAIN (JIKA ADA) :

Other Name (if any) (DALAM HURUF BESAR / IN CAPITAL LETTERS)
c)
JANTINA :
Gender:
d)
NOMBOR PASPORT :
PassportNumber:
e)
TARIKH DAN TEMPAT LAHIR :

Date and Place of Birth:
BAHAGIAN II :
Part II:
a)
LATAR BELAKANG KESIHATAN

Medical History
ADAKAH ANDA PERNAH MENGHADAPI PENYAKIT BERIKUT?

Have you every suffered from the following ailments?
YA
TIDAK JIKA YA, BERI ULASAN
Yes
No
if yes, give brief details
i.
PENYAKIT OTAK
Mental Illness
ii.
BATUK KERING
Tuberculosis
iii.
SAWAN
Epilepsy
NO. DOKUMEN
TARIKH KUATKUASA
MUKA SURAT

11 APRIL 2014
2 daripada 3
BORANG RB I
RB I Form
YA
TIDAK JIKA YA, BERI ULASAN
Yes
No
if yes, give brief details
iv.
LELAH
Chronic Asthma
v.
HEPATITIS A / B
vi.
AIDS
vii.
KENCING MANIS
Diabetes Mellitus
viii. PENYAKIT JANTUNG

Heart Disease
b)
RANGSANGAN
Senses
i.
RASA
Taste
ii.
BAU
Smell
iii.
SENTUHAN
Touch
iv.
PENGLIHATAN
Vision
v.
PENDENGARAN
Hearing
BERFUNGSI
Functioning
TIDAK BERFUNGSI
Not Functioning
NO. DOKUMEN
TARIKH KUATKUASA
MUKA SURAT

11 APRIL 2014
3 daripada 3
BORANG RB I
RB I Form
DECLARATION BY APPLICANT
, Passport No.
issued by the Government of
,
agree that:
1. All information given in the application form and the supporting documents are genuinely
correct and true; and
2. Any false information given by the applicant / Licensed Company will result in the Social
Visit Pass issued under this Programme being cancelled without further notice.
Date this
day of
(month)
(year) at
(address)
in the State of
Country
Date:
Signature of the above named
NO. DOKUMEN
TARIKH KUATKUASA
MUKA SURAT

11 APRIL 2014
1
Director
Level 1, No 2, Tower 1,
Jalan P5/6, Precinct 5,
62200 Putrajaya,
MALAYSIA.
Date:
AUTHORIZATION LETTER
I /we __________________________ Passport Number __________________ hereby attached the

financial statements for purpose of participation in Malaysia My Second Home Programme as follows:
1. Account No __________________________ from ______________________________
(the said financial institution and branch)
2. Account No __________________________ from ______________________________

3. Account No __________________________ from ______________________________

4. Account No __________________________ from ______________________________

5. Account No __________________________ from ______________________________

I /we hereby give permission/consent to the authorized officer(s) from Malaysia My Second Home Centre,
Ministry of Tourism and Culture Malaysia to verify my/our financial status or account with the said
financial institution (s).
The permission hereby given is solely for the purpose of my/ours participation in the Malaysia My Second
Home Programme.
Signature,
__________________
Name:
Address:
Telephone Number:
Appendix 12
GOVERNMENT OF MALAYSIA
Immigration Ordinance, 1959
(F.M. 12 of 1969)
Immigration of Malaysia Regulation, 1963
(F.L.W. 228/63)
PERSONAL BOND
Stamp
RM10.00
By the stamping
office in Inland
Revenue Board
of Malaysia
(Regulations 18)
Wheres it is a condition of the issue of a Visit Pass (Social Visit) to me /
of
that there furnished by me / on behalf of the said
will comply with the provisions of the Ordinance and of any
regulations made there under and with any conditions imposed in respect of, or instructions
endorsed on such pass.
Now I,
NRIC
. of
bind myself that I / the said
do
hereby
will
comply
with the provisions of the above Act and of any regulations made there under and with any
special conditions imposed in respect of, or instructions endorsed on suchVisit Pass (Social
Visit) pass and in case of my / the said
making default therein, I hereby bind myself to forfeit to the Government of Malaysia the sum of
dated this
day of
in the state of
at
.
Signature of the abovenamed
Signed and executed by the above named

In my presence
Signature of Witness
Full name of Witness
Address of Witness
Security Bond/ Bank Guarantee Rates

RM 2000.00
RM1000.00
RM1000.00
Canada
USA
Colombia
Angola
Burkina Faso
Burundi
Cameroon
Central African Republic
Republic Congo
Republic Democratic Congo
Cote D'Ivoire
Djibouti
Equatorial Guinea
Eritrea
Ethiopia
Guinea-Bissau
Ghan
Liberia
Mali Mozambique
Niger
Nigeria
Rwanda
Western Sahara
RM1500.00
Japan
South Korea
Macao
Hong Kong
Japan
South Korea
Macao
Hong Kong
RM 750.00
Saudi Arabia
Africa
Australia
British C.I
Brunei
China
Europe
Iran
Iraq
Portugal C.I
Taiwan
Tunisia
Vietnam
RM500.00
Bangladesh
Phillipines
India
Myanmar
Nepal
Pakistan
Sri Lanka
Fee for other

countries is
RM1500.00
RM300.00
RM200.00
Indonesia
Thailand
Singapore
Source : http://www.imi.gov.my/index.php/en/main-services/visa/security-bond
Last Updated on Friday, 09 March 2012 02:10
MALAYSIA MY SECOND HOME

BORANG KENYATAAN PENAJA (SPONSOR DECLARATION FORM)
(SILA SERTAKAN SALINAN KAD PENGENALAN)
Nama Penaja (Sponsors Name) :
Alamat (Address) :
No. Telefon (Telephone No.) :
1. Apakah pekerjaan dan pendapatan anda (Occupation and salary)?
2. Bagaimanakah anda mengenali pemohon (How did you know the applicant)?
3. Pernahkah pemohon datang ke Malaysia (Has the applicant come to Malaysia before)?
4. Apakah pekerjaan pemohon sekarang (Applicants present Occupation)?
5. Di mana alamat pemohon sekarang (Applicants present address)?
6. Apakah tujuan pemohon memohon program ini (Reason for applicant applying for this
Programme)?
7. Kedudukan kewangan pemohon (nyatakan jumlahnya) :

(Details of applicants financial status give the amount) :
7.1 Bank tempatan (Local bank)
7.2 Bank luar negeri (Foreign bank)
7.3 Pencen (Pension)
7.4 Saham (Shares)
7.5 Lain-lain (Others)
8. Adakah pemohon memiliki Insuran Kesihatan?
Ya/Yes
Tidak/No
(Is the applicant covered by Medical Insurance)

9. Adakah anda bertanggungjawab ke atas pemohon dengan menandatangani Personal Bond?
(Will you accept responsibility of the applicant by signing the Personal Bond)?
Ya/Yes
Tidak/No
SEGALA KENYATAAN YANG SAYA BERIKAN ADALAH BENAR.

(ALL THE ABOVE STATEMENTS ARE TRUE)
(TANDATANGAN PENAJA / SIGNATURE OF SPONSOR)

TARIKH (DATE) :

Through Agent Application Form (Complete)

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NO.

PK.(O).KPK.PSA.02 (L1) Pin.1

MALAYSIA MY SECOND HOME (MM2H) CENTRE

For agent use only

Letter of Application (by the applicant);

Include information on personal background, intention to join the MM2H Programme, if

Skills or expertise acquired

Three (3) copies of IM.12 Form Social Visit Pass

Two (2) Photostat copies.

Four (4) coloured passport sized photographs (3.5 x 5.0 cm)

Copy of Passport/ Travel documents

Two (2) copies of personal particulars page

Note : Copy of the previous passport is required if main applicant/dependent(s) has

Personal Bond is to be submitted for main applicant only

Letter of Good Conduct from main applicants relevant government agency

PK.(O).KPK.PSA.02 (L1) Pin.1

MALAYSIA MY SECOND HOME (MM2H) CENTRE

For agent use only

Self declaration on main applicants/ dependents health conditions Form RB I

Certified copy of Marriage Certificate (if accompanied by spouse)

Letter of Confirmation from Medical Specialist/ General Practitioner (if accompanied by

PK.(O).KPK.PSA.02 (L1) Pin.1

MALAYSIA MY SECOND HOME (MM2H) CENTRE

MALAYSIA MY SECOND HOME (MM2H) CENTRE

For agent use only

Surat iringan daripada Syarikat Berlesen MM2H;

Salinan lessen syarikat berlesen MM2H yang masih sah tempoh

Surat pengesahan wakil sebagai pekerja di bawah Syarikat Berlesen MM2H

Submissions of application by employees of the MM2H Licensed Company other than

Borang kenyataan Penaja (perlu dilengkapkan oleh syarikat berlesen MM2H)

Surat pengesahan daripada Bahagian Pelesenan Pelancongan, Kementerian Pelancongan

PK.(O).KPK.PSA.02 (L10) Pin.1

FOR INDIVIDUAL APPLICANT / SPOUSE (THROUGH MM2H LICENSED COMPANY) v1.2

MINISTRY OF TOURISM AND CULTURE MALAYSIA

Fax: +603 88917414

APPLICATION FORM FOR THE MALAYSIA MY SECOND HOME PROGRAMME

Please tick for applied category:

Please tick if applicant is accompanied by

Please tick location of stay

Monthly government pension of RM10,000

Full Name (Capital Letters)

Marital Status [Please tick ()]

Place of Birth (Country)

Date of Birth (dd/mm/yyyy)

PK.(O).KPK.PSA.02 (L10) Pin.1

FOR INDIVIDUAL APPLICANT / SPOUSE (THROUGH MM2H LICENSED COMPANY) v1.2

Date of Expiry (dd/mm/yyyy)

E-mail Address (if any)

If currently employed (Q13 Q16):

Income (Per Annum)

PK.(O).KPK.PSA.02 (L10) Pin.1

FOR INDIVIDUAL APPLICANT / SPOUSE (THROUGH MM2H LICENSED COMPANY) v1.2

Last Employer/ Organisation

Address of Last Employer/

PK.(O).KPK.PSA.02 (L10) Pin.1

FOR INDIVIDUAL APPLICANT / SPOUSE (THROUGH MM2H LICENSED COMPANY) v1.2

C. DECLARATION BY DIRECTOR OF MM2H LICENSED COMPANY

Signature of the above named:

Signed and executed by the above named in my presence:

Full name of Witness

Passport/ MyKad Number :

PK.(O).KPK.PSA.02 (L10) Pin.1

FOR INDIVIDUAL APPLICANT / SPOUSE (THROUGH MM2H LICENSED COMPANY) v1.2

* For office use only:

I /we ________ Passport Number hereby attached the

2. Account No from ____

3. Account No from ____

4. Account No from ____

5. Account No from ____