FORM 48B. Application For Company Secretary's Licence. (COMPANIES REGULATIONS, 1966

P.U. 173/66
COMPANIES REGULATIONS, 1966
SECOND SCHEDULE (Regulation 3)

FORM 48B. Application For Company Secretary's Licence.

FORM 48B

Photograph
of
Applicant

Companies Act, 1965
(Section 139B (1))

APPLICATION FOR COMPANY SECRETARY'S LICENCE

Application is made for Company Secretary's Licence under the Companies Act 1965 and the following statements are made in respect thereof.

*NOTE:

If space is insufficient to provide details, please attach annexure (s). Any such annexure(s) should be identified in accordance with Regulation 6A.

A. (i) Name of applicant: ...................................... (In Block Letters)

NRIC No:......................................

(ii) Residential address: ......................................

Tel. No : ......................................

(iii) Office address: ......................................

Tel. No:......................................

(iv) Date and place of birth: ......................................

(v) Male/Female: ......................................

B. Academic or professional qualification

___________________________________
(Please attach photocopy of certificate of qualification)

C. Years of experience in Secretarial Practice......................................

(Please attach relevant documentary / evidence relating to the experience. )

D. Details of one person with whom the applicant has had regular contact over the past five years and of whom the Registrar may enquire regarding the applicant's character.

(i) Name:

......................................

NRIC No:

......................................

(ii) Address:

......................................

Tel. No:

......................................

(iii) Occupation:

......................................

(Please attach letter from above referee)

E. Declaration:
I ......................................do solemnly and sincerely declare that:

(a)

I am not an undischarged bankrupt;

(b)

I have not been convicted whether within or without Malaysia of any offence -

(i) in connection with the promotion, formation or management of a corporation;

(ii) involving fraud or dishonesty punishable on conviction with imprisonment for three months or more; or

(iii) under section 132, 132A or 303,

within a period of five years preceding the date of this declaration;

(c)

all information given in this application and in the attached annexure(s) (if any) is true and correct.

Dated this ...................................... day of ......................................, 19 ......................................

......................................
Signature of Applicant

FOR THE REGISTRY'S USE ONLY

Remarks	Date Approved	Date Rejected	Licence Number	Officer

ANNEXURE A

LIST OF COMPANIES WHEREBY APPLICANT IS
APPOINTED AS SECRETARY

No.	Company Number	Name of Company	Appointment Date	Office Use

NOTE:

This annexure is to be completed and attached to Form 48B.

(Ins.P.U.(A) 80 /1993:s.5)