PERSATUAN ALUMNI UNIVERSITI MALAYA 2

PAUM ORDINARY / ASSOCIATE MEMBERSHIP Photographs

APPLICATION FORM

PERSONAL PARTICULARS Full Name: _____________________________________________________________________________ Name on Graduation (if different from above): _________________________________________________ I/C No.: _____________ (Old) ______________________ (New) Gender: Male / Female (Please Circle) Marital Status: ___________Date of Birth: ___/___/______ Place of Birth: __________________________ UM Degree(s) & Year(s): __________________________________________________________________ Other Degree (s) & Year (s): ____________________________________________________________________ Home Address:__________________________________________________________________________ _________________________________________________________________ Postcode: _____________ Occupation / Designation: _________________________________________________________________ Name of Employer / Company: ______________________________________________________________ Office Address: __________________________________________________________________________ _______________________________________________________________________________________ _________________________________________________________________ Postcode: _____________ Tel: (Office): ______________ (House): ______________ Mobile: ____________Fax:_________________ Email: _________________________________________ Mailing address: Home / Office (Please Circle) Interests: _______________________________________________________________________________

Name of Spouse:

UM Degree & Year (if applicable):

Names of Children:

DECLARATION & SIGNATURE I, _______________________________________________ the undersigned, do hereby declare that the particulars in this application form are correct. I also agree to abide by the Constitution and Regulations of the Persatuan Alumni Universiti Malaya. ____________________________________________ _____________________

Signature of Applicant Date

PROPOSER & SECONDER (Optional) Name of Proposer Ordinary Membership No Signature Date

Name of Seconder Ordinary Membership No

MEMBERSHIP INFORMATION 1. ELIGIBILITY FOR MEMBERSHIP

(a) ORDINARY MEMBERSHIP is open to all persons who are on the register of graduates of University of Malaya.

(b) ASSOCIATE MEMBERSHIP is open to graduates of other universities in Malaysia or overseas (c) Applications for membership shall be proposed and seconded by Ordinary Members of PAUM. (d) Admission to PAUM is at the sole discretion of the Executive Committee.

Please note that spouses and children (under the age of 18) of members will be issued supplementary cards for the use of the clubhouse facilities. (Terms & conditions apply).

2. ENTRANCE FEE AND ENTRANCE FEE PAYMENT

The pre-opening promotion entrance   fee   rate   of   RM1,060.00   (inclusive   of   6%   GST)   for   Ordinary   /  Associate  Memberships.      

3. SUBSCRIPTION FEE & REFUNDABLE DEPOSIT The monthly subscription is RM63.60 (inclusive of 6% GST) for Ordinary / Associate Memberships with effect from 1 May 2016. A refundable deposit of RM500.00 is payable upon application.

4. DOCUMENTS TO ACCOMPANY APPLICATION FORMS

To expedite processing, please complete the form in full and attach the following:

(a) A cheque payable to PERSATUAN ALUMNI UNIVERSITI MALAYA for RM1,623.60 (RM1,060.00 for the promotional entrance fee, RM63.60 for the first monthly subscription and RM500.00 as refundable deposit) OR you may GIRO the sum directly into PAUM Maybank account no. 5141-5032-9835 with notification of payment to ellen.loh@UMAlumni.my.

(b) Two (2) passport size photographs of applicant, spouse & children 12 - 18 years for issuance of membership cards with door access. Please note that RM50.00 is chargeable for replacement of lost cards.

(c) Photocopy of degree. 5. Please post to : The Honorary Secretary

Persatuan Alumni Universiti Malaya Rumah Kelab PAUM Lot 10476, Jalan Susur Damansara (Jalan Damansara Lama) 59100 Kuala Lumpur

Tel 03 – 2093 1235 (Hunting line) Fax : 03 – 2093 6235

FOR OFFICE USE

RECEIPT Verified by:…………………………. Date:…………….....

ACKNOWLEDGEMENT

CHOP Date received by PAUM:….:………………….

APPLICATION APPROVAL:

Exco Meeting No. ……………. Date:………………..

Membership No. :……………

Date Membership card issued:……………….………………...

Payment particulars: Cash / Cheque No:……………………...

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