APPENDIX APSMB/TP/1/09

APPLICATION TO REGISTER AS A TRAINING PROVIDER WITHPEMBANGUNAN SUMBER MANUSIA BERHAD

Only one copy of this form is required.

All items in this form must be completed. Where the space provided is not adequate, please provide the information on a separate sheet and attach it to the form. Where information is not yet available or not applicable, please indicate accordingly. All information given will be held in the strictest confidence.

CHECKLIST

1. Completely Filled Form PSMB/TP/1/09.2. Processing Fee (Category A – RM1, 300; Category B / B (HO) – RM800.00; New Branch – RM700)

in the form of cheque, postal order, money order or bank draft made payable to “PEMBANGUNAN SUMBER MANUSIA BERHAD”.

3. A copy of registration of company/business/association. (Form 9,24 and 49)4. A copy of Memorandum and Article of Association of the company which reflected that

one of the objects of the company is training and consultancy services."5. A copy of tenancy agreement/ ownership of property together with stamping etc. for verification

of training premise.6. A list of training programmes offered and course outline for each training programme.7. *A list of name(s) of supporting staff and their I.C Number(s).8. Biodata of trainers full-time and part-time.9. List of in-house or public programmes that have been conducted in the past one (1) year

together with date of commencement, trainers’ name, number of trainees, number of companies which have sent the participants, names and contact person of the employers.10 A copy of “Train-The-Trainer” certificate or Letter of Exemption from PSMB.11 *The minimum size for a training room/laboratory under Category A must be at least 35 meter²

irrespective of the length and width.

GENERAL INFORMATION

Types of Application [Please tick ( ⁄ ) in the appropriate box]

(1) Category A Certificate of Training Provider’s Registration

(2) Category B Certificate of Training Provider’s Registration

/ (3) Category B (HO) Certificate of Training Provider’s Registration

1. Name and Address of Training Institution/Provider (Business Address):- Lot 2935, Ground Floor, Faradale Commercial Centre98000 Miri, Sarawak.

(Please attach a copy of Business Registration/Certificate of Incorporation)

Telephone No. : 085 43599

Fax No. : 085 432214

Email: bernard_sim@yahoo.com

Website : www.teaengineers.org

2. Types of Organization [Please tick (/) in the appropriate box]

(1) Government/Semi Government Institution

(4) Private Training Institution

(7) Company with Excess Well-established Training Facilities

/(2) Association/Industry-based Training Centre (2)

(5) Vendor of Equipment/Packages/Software

(8) OthersPlease specify : _________

(3) Non-profit (6) Consulting Firm

MyCoID

Organization

3. Ownership [Please tick (/) in the appropriate box]

/(1) 100% local (3) 100 % Foreign

(2) Government (4) Foreign/ Local Joint Venture

Foreign Countries : __________ %Foreign : __________

4. * No. of Employee(s): _____0______

5. No. of Trainer(s) Full-time : ____0_____ Part-time : _____3___

6. (a) Training Facilities (compulsory for Category A) Yes/

No

If yes, please specify:i. _________________________________________________________________________ii. _________________________________________________________________________iii. _________________________________________________________________________Please enclose document of training centre.

(b) Have you offered your training programmes to the public?

/ Yes No

If yes, please list out the training programmes that you have conducted for the past one(1) year and the number of trainees/participants who had attended the training programmes. (Please attach a separate sheet)

7. We declare that we are applying to register as a training provider with PSMB and will be submitting training programmes that will be offered to the public:-

(1) Fundamental of Welding Inspection(2) Fundamental of Painting Inspection(3) Fundamental of Magnetic Particle Testing(4) Fundamental of Dye Penetrant Testing(5) Fundamental of Ultrasonic Testing(6) Radiographic Interpretations(7) Metallurgy and Welding Inspection (8) IACS Recommendations 47 : Ship Building and Repair Interpretations(9) Piping Inspection for Shipbuilding

(Please use a separate sheet of paper if the space provided is insufficient)

8. We declare that the facts stated in this application form and the accompanying information are true and correct and that we have not withheld/distorted any material facts.

We understand that if we obtain the approval status by false or misleading statements, we may be prosecuted under Section 41 of Pembangunan Sumber Manusia Berhad Act 2001 (Act 612) and in addition, Pembangunan Sumber Manusia Berhad may, at its discretion, withdraw the approval status immediately.

SIGNATURE : ________________________ SIGNATURE : _______________________________

NAME & DESIGNATION : ___Dr. Edwin Jong______

NAME & DESIGNATION:___Lee Chung Kiong___

(President) (Treasurer)

DATE : __________________________

+ Delete where inapplicable

* If applicable