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Malaysian Rubber Exchange

Ordinary Membership Application

Form No. I
Application For Ordinary Membership Of The
Malaysian Rubber Exchange
         
  1. Name of Applicant :
Company's Name
    Official Address :
   
    Postcode :
    State :  
    Tel No :
    Fax No :  
    E-mail :
                                                                              
  2. Membership Classification Applied For :  
   

     
  3. (a) Constitution of Business :  
   

     
   
(b) Date of Incorporation/Registration : dd/mm/yyyy
   
(c) Country of Incorporation/Registration :
     
  4. (a) Nature of business being   :


 
     
    (b) Type of  : 
     
    (c) Number of years in rubber/rubber products business:
     
    (d) Type of licence(s) under Regulation 6 of the Malaysian Rubber Board (Licensing) Regulations, 1997 :
   
To Buy Rubber (Ai)  To Buy Rubber for Manufacturing Rubber Product (C)
To Sell Rubber (Aii) To Treat Rubber (B)
To Germinate, Grow, Plant or Transplant Rubber Planting Material (D)
     
    (e) Type of certificate(s) under Sub-regulation 37(1) of the Malaysian Rubber Board (Licensing) Regulations 1997 :
To Pack Rubber for Export (CC) To Ship Rubber for Export (DD)  
To Ship Rubber Glove for Export (EE)
     
  5. Paid-up Capital 
    (a) Amount : RM     
    (b) Ownership structure
 
(i)
 Malaysian         
  Bumiputra   %  
  Non-Bumiputra   %  
   
(ii)
 Non-Malaysian       
Nationality        
RM   % 
RM   % 
RM   % 
                                                      
  6. Bank Guarantee (if applicable)
   
Amount :
RM  
   
Banker's Name :
 
   
Address :
     
  7. Particulars of Directors/Partners and Principal Officers*:
   
Directors/Partners Principal Officers
* as at date of application
     
  8. Trade Association/Affiliation (if any):
   
     
  9. Bank Confidential Report from :
Name of Bank:
Address :
       
    Applicant's Name :
    Designation :  
    Application Date : 03 September 2010  
     
    By submitting this form, you indicate that you agree to forward your application to the Malaysian Rubber Exchange for processing to become a member.