PERSATUAN WAKIL-WAKIL PENGHANTARAN KARGO PULAU PINANG PENANG FREIGHT FORWARDERS ASSOCIATION (PFFA)

Transcription

1 APPENDIX A PERSATUAN WAKIL-WAKIL PENGHANTARAN KARGO PULAU PINANG PENANG FREIGHT FORWARDERS ASSOCIATION (PFFA) MEMBERSHIP APPLICATION FORM ORDINARY /ASSOCIATE 1. REGISTERED NAME OF COMPANY:. 2. PUBLIC / PRIVATE LIMITED / PARTNERSHIP / SOLE PROPRIETORSHIP 3. FOREIGN JOINT-VENTURE / FOREIGN OWNERSHIP Please give name of foreign partner or parent body and the business of the said party. NAME & ADDRESS (Overseas). BUSINESS A. CERTIFICATE OF INCORPORATION IN MALAYSIA (Companies Act) B. CERTIFICATE OF REGISTERED IN MALYSIA (Companies Act) C. CERTIFICATE OF REGISTRATION (Business Ordinance) or any other Law applicable to the business if the Applicant e.g. Certified True Copy & originally signed by Company Secretary, latest copy of Form 24 & 49 and Memorandum and Articles of Association. 5. TYPE OF AGENCY / CUSTOMS BROKERS /REGISTERED & APPROVED BY THE MALAYSIAN CUSTOMS & EXCISE DEPT: FORWARDING AGENCY / SHIPPING AGENCY 6. FILE NUMBER WITH THE MALAYSIAN CUSTOMS & EXCISE DEPT. AND THE DATE OF THE LATEST RENEWAL : DATE:. FILE NO:. 7. DESCRIPTION OF PRINCIPAL BUSINESS ACTIVITIES : Airfreight / Seafreight /Railway / Road Forwarding / etc.. 1

2 8. AUTHORISED CAPITAL: RM:.. PAID-UP / ISSUED : RM: 9. ADDRESS OF REGISTERED OFFICE IN MALAYSIA.: ADDRESS OF OFFICE IN PENANG... TEL: FAX:.. ADDRESS:. 11. CORRESPONDENCE ADDRESS (If different from No. 10) TYPE OF AIR FREIGHT AGENCY: IATA / NON-IATA 13A. IF IATA AGENCY, PLEASE STATE IATA AGENCY NO. : 13B. DATE OF COMMENCEMENT OF IATA AGENCY :. 13C. IF NON-IATA AGENCY, PLEASE STATE AIRLINES APPOINTING YOU AS AN AGENT AND THE DATE OF APPOINTMENT (Please enclosed copies of Certificate(s) of appointment) AIRLINES :. AIRLINES : AIRLINES : DATE:. DATE:. DATE: IF SHIPPING AGENCY, PLEASE NAME THE LINES REPRESENTING: A... NATIONALITY.. B. NATIONALITY 2

3 15. LIST OF PRINCIPAL SHAREHOLDERS / PARTNERS BY NATIONALITY & EQUITY HOLDING (If insufficient space, please add sheet) NAME NATIONALITY EQUITY A.... B. C DIRECTOR / PARTNER (If insufficient space, please add sheet) NAME NATIONALITY EQUITY A.... B.. C NAME AND TITLE OF CHIEF EXECUTIVE IN PENANG: NAME:. NRIC : 18. NAME, IDENTITY CARD / PASSPORT NO. OF ACCREDITED REPRESENTATIVE NAME:. (Accredited Representative) PHOTO STATUS:. NRIC / PASSPORT NO :. DATE NOMINATED:. NAME:.. (Alternate Representative) PHOTO STATUS:. NRIC / PASSPORT NO:. DATE NOMINATED: 19. IF A MEMBER OF ANY OTHER ORGANISATION SIMILAR TO PFFA, PLEASE 3

4 STATE :.. The President PENANG FREIGHT FORWARDERS ASSOCIATION Block A, Unit 9, MAS Aircargo Complex Penang International Airport Jalan Garuda, Bayan Lepas Penang. Dear Sir, We/I.. desire to become as a member of the Penang Freight Forwarders Association. Our/My particulars are given in the preceding pages of this Application Form and we are true to the best of our / my knowledge. We undertake, if elected, as a Member of the Penang Freight Forwarders Association, to be bound by the Constitution of the Association. Enclosed, please find our / my Cheque No... issued from Our / my Bank amounting to Malaysian Ringgit RM:. being payment for Entrance Fee and One Year Subscription in advance. (Please note, if cheque is from out of Penang, please include Bank Commission on top of the total amount due to the Association.) Yours Faithfully Date :. Signature & Company Stamp Name of Signee: PROPOSED BY (Name & Address of Ordinary Member of PFFA).. Singature & Company Stamp Name of Signee: Designation : SECONDER BY (Name & Address of Ordinary Member of PFFA). Singature & Company Stamp Name of Signee: 4

5 Designation : We / I as stated above as the Applicant, wish to also apply for classification under the jurisdiction of the following Divisional Board, subject to the approval of the Association. [Choose only One (1)]. ( ) AIRFREIGHT DIVISION ( ) SEAFREIGHT DIVISION Yours Faithfully. Signature & Company Stamp Name of Signee: END

6 FOR OFFICIAL USE ONLY ENTRANCE FEE RECEIVED DATE :. AMOUNT RM :. BANK: CHEQUE NO... SUBSCRIPTION FEE FOR ONE YEAR RECEIVED DATE :. AMOUNT RM : BANK : CHEQUE NO. RECEIPT ISSUED DATE : RECEIPT NUMBER: APPROVED / REJECTED DATE APPLICATION RECEIVED :.. DATE OF APPROVAL / REJECTION : COUNCIL MEETING : CONFIRMED BY:.. PRESIDENT.. HON.SECRETARY-GENERAL APPROVED BY AIRFREIGHT / SEAFREIGHT DIVISION DATE:.... CHAIRMAN HON.SECRETARY 6