ISM-QR-S7-01 QS (Version 2.

0) FORM A2
8 October 2007

PERTUBUHAN JURUUKUR MALAYSIA

The Institution of Surveyors, Malaysia
Tingkat 3, Bangunan Juruukur, 64-66, Jalan 52/4, 46200 Petaling Jaya, Selangor Darul Ehsan
Tel: 03-7954 8358 Fax: 03-7955 0253 Email: qsdiv@ism.org.my

APPLICATION FOR ENROLMENT AS A FULL MEMBER

A.
(DIRECT ENTRY SCHEME FOR REGISTERED QUANTITY SURVEYORS)

PERSONAL PARTICULARS
Division: Quantity Surveying
M
Full Name: PASSPORT
(in CAPITAL LETTERS) SIZE
PHOTO
Sex: Male / Female Date of Birth:
Place of Birth:
Nationality:
Identity Card (for Malaysians) or Passport (for non-Malaysians) No:
(New): (Old):
Business Name and Address: FOR OFFICE USE ONLY

Date Received :
Date Referred To
Division :
Recommended On :
Tel: Fax: Admission Date :
Mobile: Email: Notification :
House Address: Membership No :
Signature of
Membership
Tel: Review Chair :
Date :

B. ACADEMIC QUALIFICATIONS

a) Diploma (state qualification, year of graduation and academic institution):

b) QS-based Degree (state qualification, year of graduation and academic institution):

c) Other degrees (state qualification, year of graduation and academic institution):

C. OTHER PROFESSIONAL QUALIFICATIONS AND TRAINING

a) Board of Quantity Surveyors Malaysia Registration No:

b) Other Professional Qualifications (state name of qualification, date admitted and awarding body):

c) If the ISM Final or Direct Final Exams or other equivalent were taken, please state year of passing:

d) Work experience (state employers name, year of employment and designation):

(attach separate list if necessary)
i)
ii)
iii)
iv)
v)
vi)

D. EMPLOYERS DECLARATION

a) The applicants designation is:

b) The applicants duties are (generally):

c) Name and qualifications of the applicants immediate superior:

d) Signature of Employer:

Name of Employer in CAPITAL LETTERS:

Qualifications:

Name of Organisation:

Date:
 E. PROPOSER AND SECONDERS
EITHER I) The Proposer is a Fellow. The Seconders may be Fellows or Members.
OR II) The President is the Proposer and one council member as the Seconder.

I recommend the applicant as a person worthy of being accepted into The Institution of Surveyors, Malaysia
as a full Member.

PROPOSER SECONDER SECONDER

Signature:

Name:
(in CAPITAL LETTERS)

ISM membership no:

(leave blank if not immediately available)

Name of
Organisation:

Address:

Date:

F. APPLICANTS DECLARATION

I certify that the particulars stated in A, B and C above are correct

and
I duly confirm that I am a new applicant.

Signature :

Name :

Date :

Checklist of attachments:

2 passport-sized photos;

A photocopy of Identity Card (Malaysians) / Passport;

A certified true copy of all diplomas and degrees from the relevant universities and
BQSM registration certificate (to be certified by the Proposer in the following manner I
have personally examined the original certificate and certify that this is a true copy;

One official letterhead (specimen) from your office/department.

Form on Education/Working Experience History (as attached)