ECER Secretariat. Level 22, Menara 3, Kuala Lumpur City Centre, Kuala Lumpur. Tel : / 22 Fax :

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1 ECER Secretariat Level 22, Menara 3, Kuala Lumpur City Centre, Kuala Lumpur Tel : / 22 Fax : Website : prequal@ecerdc.com.my CONSULTANT PRE-QUALIFICATION REGISTRATION FORM relating to ECER. The ECER Secretariat and ECERDC reserves the right to accept, decline or respond to any submission of

2 REGISTRATION FORM 1>COMPANY / INDIVIDUAL BACKGROUND 1.1 Company / Individual Details Name Address Postcode State Telephone No. Fax No. Contact Person Mobile phone No Address Branch Address Postcode State Telephone No. Fax No. Contact Person Mobile phone No Address 1.2 Company Registration Place of Incorporation Company Reg. No. (ROC/ROB/Permit No) / NRIC No Date of Incorporation Income Tax No 1.3 Financial Background Capital Authorized Capital (as per Form 24 where applicable) Paid-Up Capital (as per Form 24 where applicable) Working Capital RM RM RM Bankers/ Financiers Bank/Institution Account No. Facilities (if any) 1.4 Equity Participation Company Status Bumiputera % Non-Bumiputera % Foreign % 2

3 1.5 Registration With Agencies/Authorities Agencies/Authorities Registration No Type of Works Validity (mm/dd/yyyy) Ministry of Finance Association of Consulting Engineers Malaysia Board of Engineers Board of Architects Board of Land Surveyors Board of Valuers & Appraisers & Estate Agents Board of Quantity Surveyors Institute of Interior Design Malaysia Institute of Landscape Architects Malaysia Institute of Urban Planning Malaysia Department of Environment Public Service Department Ministry of Plantation Industries & Commodities Ministry of Agriculture and Agro-Based Industry Ministry of Rural and Regional Development Ministry of Natural Resources and Environment Ministry of International Trade and Industry Ministry of Domestic Trade and Consumer Affairs Ministry of Entrepreneur and Cooperative Development Ministry of Works Ministry of Transport Ministry of Energy, Water and Communications Ministry of Science, Technology and Innovations Ministry of Tourism Ministry of Education Ministry of Health Ministry of Housing and Local Government Ministry of Culture, Arts and Heritage Ministry of Youths and Sports Ministry of Human Resource Ministry of Information Ministry of Women, Family and Community Development Ministry of Higher Education 3

4 2.0> Specialisation (please tick) Sector Sub-sector Tick ( ) Business Financial (Audit / Tax / Corporate Finance / Investment Banking) Management (Consultancy / Corporate Advisory / Secretarial) Economics Construction Architecture Civil & Structural Engineering Mechanical & Electrical Engineering Geotechnical Engineering Quantity Surveying Landscape Architecture Town / Urban Planning Environmental Impact Assessment Land / Property Property Consultant Valuation Land Survey Property Development / Investment Developer Investment Trustee Transport Traffic Impact Assessment Infrastructure / Utilities Flood Mitigation Drainage, Sewerage Sanitary Landfill Water, Electricity, Tourism Coastal Tourism Island Tourism Urban Tourism Integrated Resort Development Cultural (Handicraft & Heritage)Tourism Logistics Supply Chain Management Port Management Fleet Management Marina / Fisheries / Aqua Petrochemicals (Plastics) Industrial / Operational / Mechanical Agriculture - Crops Fruits Vegetables Kenaf Cocoa Herbs Agriculture - Fisheries Fisheries Agriculture - Livestock Cattle Goat Poultry Manufacturing Education Environment State Park / Forest Flora & Fauna Mapping State Liason International Market Research / International Expert Branding / Marketing Halal Industry Social Community Others (please specify) Others (please specify) Universities Polytechnics Community Colleges Integrated Knowledge Parks Research Centres Training Programmes Coastal Protection 4

5 3.0> KEY PERSONNEL 3.1 Top / Senior Management Name Designation IC No. / Passport No. Citizenship Years of Experience Speciality 3.2 Major Shareholders/ Board of Directors (as per Form 24/ Form 49 where applicable) Name IC No. / Passport No. Citizenship 3.3 Personnel Strength - Local Participation Management Executive Clerical General Worker Professional Admin Senior Junior Admin Bumiputera Non-Bumiputera Foreign TOTAL 3.4 Personnel Strength - Worldwide Region Partners Professionals Total Staff Offices Africa Asia Pacific Europe Americas TOTAL 5

6 4.0> OFFICE FACILITIES 4.1 List of IT Hardware 4.2 List of IT Software 4.3 Office Premises 4.4 Insurance / Professional Indemnity 6

7 5.0> PROJECT PORTFOLIO List of Projects Undertaken Sector Sub-sector Project Description Client Description Social Development Agropolitan Land Development Tourism Coastal Tourism Integrated Resort Development Eco Tourism Cross Border Tourism Urban Tourism Handicraft & Heritage Tourism Manufacturing Palm Oil Rubber Food Processing Halal Products Transport Roads Bridges Ports Bus Airports Rail Signage Agriculture - Crops Fruits Vegetables Kenaf Cocoa Herbs Agriculture - Fisheries Agriculture - Livestock Industrial Parks Property Education ICT Infrastructure Entrepreneurial Development Land Fisheries Cattle Goat Poultry Palm Oil Cluster Furniture Plastics Boat Building Heavy Industry Residential Commercial Integrated City Centre Industrial Centre Real Estate Trust Universities Polytechnics Community Colleges Sports Schools Training Programmes Cyber Centre ICT for Schools Digital Business Exchange Animation Flood Mitigation Drainage Coastal Protection Sewerage Waste Marketing Branding BCIC Development SME Development Land Survey Value (RM) Scope Year Completed In Progress Upon completion, please to prequal@ecerdc.com.my 7

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