The Institution of Engineers, Malaysia

Bangunan Ingenieur, Lots 60/62, Jalan 52/4, Peti Surat 223 (Jalan Sultan), 46720 Petaling Jaya, Selangor Darul
Ehsan, Malaysia. Telephone : 603-79684001 / 79684002
Email : sec@iem.org.my Fax No : 603-79577678
Homepage: www.myiem.org.my

BORANG IE M / C O MP A N IO N
FORM IEM/COMPANION

PERMOHONAN KEMASUKAN KEPADA GRED COMPANION

APPLICATION ADMISSION TO THE GRADE OF COMPANION

ARAHAN KEPADA PEMOHON

INSTRUCTION TO APPLICANT
Sila baca dengan teliti sebelum mengisi Borang IEM/Companion
Please read this and comply before completing Form IEM/Companion

1.

Sila isi borang dengan lengkap. Borang ini boleh ditaip atau ditulis dengan huruf besar.
Please fill in all particulars requested. This form can be typewritten or handwritten in neat block letters.

2.

Sila sertakan sekeping gambar paspot terbaru.

Please attach one copy of your recent passport photograph

3.

Syarat kelayakan
Requirement

Pemohon untuk kemasukan atau pemindahan ke gred ini hendaklah mengemukakan bukti yang memuaskan untuk
kehendak Majlis: An applicant for admission or transferred into this grade shall produce evidence to the satisfaction of the Council:-

i)

bahawa dia telah lulus dengan ijazah kejuruteraan yang diiktiraf atau telah mendapat kelulusan yang setaraf
dengannya yang diluluskan oleh Majlis, dan
that he has graduated with an accredited engineering degree or has obtained an equivalent qualification approved by the Council,
and

ii) mempunyai tidak kurang daripada 8 tahun pengalaman atau pendedahan dalam bidang kejuruteraan dan memegang
jawatan tinggi dan
has not less than 8 years experience or exposure in the field of engineering and holding a senior position; and

iii) pemohon hendaklah melampirkan

kejuruteraan.

resume / biodata dan laporan pengalaman atau pendedahan dalam bidang

the applicant is required to submit his curriculum vitae / biodata and report of working experience on exposure to engineering.

4.

Bayaran
Payment

Pemohon dikehendaki membuat bayaran sebanyak RM235 [(Yuran Kemasukan (RM80)+Yuran Tahunan (RM155)]
dalam bentuk Cek/ Wang Pos atas nama The Institution of Engineers, Malaysia atau secara tunai di IEM, HQ.
The applicant is required to make payment of RM235 [(Admission Fee (RM50) + Annual Subscription (RM155)] in the form of a
Cheque/Postal Order payable to The Institution of Engineers, Malaysia or by cash (walk-in) at IEM, HQ.

SEMUA DOKUMEN MESTILAH DISAHKAN OLEH PENCADANG/PENYOKONG

ALL DOCUMENTS MUST BE CERTIFIED BY THE PROPOSER/SECONDER

KEGAGALAN UNTUK MEMATUHI ARAHAN DI ATAS AKAN MENGAKIBATKAN KELEWATAN DALAM

PEMPROSESAN PEMOHONAN ANDA.
FAILURE TO COMPLY WITH THE ABOVE WILL RESULT IN THE DELAY IN PROCESSING YOUR APPLICATION.

(Nota: Sebarang keraguan jika ada; interpretasi dalam Bahasa Inggeris adalah muktamad)
(Note: Should there be any doubt; the interpretation in English is final)

Implementation Date: August 2013

The Institution of Engineers, Malaysia

Bangunan Ingenieur, Lots 60/62, Jalan 52/4, Peti Surat 223 (Jalan Sultan), 46720 Petaling Jaya, Selangor Darul
Ehsan, Malaysia. Telephone : 603-79684001 / 79684002
Email : sec@iem.org.my Fax No : 603-79577678
Homepage: www.myiem.org.my

CHEKLIST BORANG PERMOHONAN

APPLICATION CHECKLIST

Sila periksa dan pastikan dokumen-dokumen berikut telah lengkap dan DISAHKAN oleh Penyokong/Pencadang sebelum
dihantar bersama borang permohonan ke IEM.
Please check the following and submit together with the application form duly CERTIFIED by your Proposer or Seconder to the IEM.

Borang IEM/(Companion)
Form IEM/ (Companion)

1 keping gambar ukuran paspot

1 passport size photo

1 salinan Surat/Sijil Pendaftaran Siswazah Lembaga Jurutera Malaysia (ini adalah untuk rekod IEM)
1 copy of the BEM letter / certificate as a Graduate Engineer (this is for IEM record)

1 salinan Ijazah Kejuruteraan dan transkrip akademik

1 copy of degree certificate and academic transcript
i)

Salinan ijazah Kejuruteraan dari Universiti tempatan hendaklah dikemukakan dalam Bahasa Malaysia atau
Bahasa Inggeris. Ijazah Kejuruteraan Luar Negara yang menggunakan bahasa ibundanya selain dari
Bahasa Inggeris hendaklah dikemukakan bersama terjemahannya oleh Pendaftar Universiti/Pegawai
Kedutaan dll.
Photocopies of engineering certificates from local universities in Bahasa Malaysia or English version are to be
submitted. Engineering certificates from oversea universities issued in foreign languages must be accompanied by
translation obtained from the University / Embassy Officials etc.

ii)

Salinan Transcript of Academic Record atau Details of course and subjects yang diambil semasa di
Universiti mestilah dikeluarkan oleh pihak Universiti.
Copies of Transcript of Academic Record or Details of course and subjects taken at the University must be
issued by the University where the applicant had attained the degree.

Tandatangan Pencadang & Penyokong

Signature of Proposer & Seconder

Tandatangan Pemohon
Signature of applicant

1 salinan laporan Latihan dan Pengalaman / Curriculum Vitae yang telah DISAHKAN oleh Pencadang/Penyokong
dari disiplin yang sama dengan Pemohon.
1 copy of the Training and Experience Report / Curriculum Vitae CERTIFIED by the Proposer/Seconder of the same discipline of
the applicant

RM235 [(Yuran Kemasukan (RM80) + Yuran Tahunan (RM155)]

RM235 [(Entrance Fee ( RM80) + Annual Subscription (RM155)]

Implementation Date: August 2013

BORANG : IEM/Companion

Permohonan bertaip atau dalam tulisan yang terang hendaklah diserahkan kepada:
This application should be typewritten or neatly written and forwarded to :

FORM : IEM/Companion

INSTITUSI JURUTERA MALAYSIA (IJM)

The Institution of Engineers, Malaysia (IEM)
Bangunan Ingenieur, Lots 60/62, Jalan 52/4, Peti Surat 223 (Jalan Sultan), 46720 Petaling Jaya, Selangor Darul Ehsan,

Malaysia.
Telephone : 603-79684001 / 79684002

Fax No : 603-79577678

Email : sec@iem.org.my

PERMOHONAN KEMASUKAN KEPADA GRED COMPANION

APPLICATION FOR ADMISSION TO THE GRADE OF COMPANION

Sila rujuk kepada ARAHAN-ARAHAN KEPADA PEMOHON untuk mengisi borang ini.
Please refer to the INSTRUCTION TO APPLICANT to fill in.

Passport
Photo

1. BUTIRAN PERIBADI
PERSONAL PARTICULARS

Nama Penuh :
Full Name

Alamat Tetap:
Permanent Address

Alamat Pos :
Postal Addresss

Nombor Telefon (R) :

...
...

Telephone Number (H)

..........................

Pejabat:

Office

Tempat Lahir:

Age:

Tarikh Lahir:

Mobile:

Emel :

Email Address:

Place of Birth:

Umur:

Bimbit :

Bandar: ..

Negeri:

Town

State:

Nombor Kad Pengenalan: ..

I.C. No

Date of Birth:

Kewarganegaran: .
Nationality:

(Perhatian : Sebarang perubahan alamat, nombor telefon pekerjaan hendaklah diberitahu kepada IJM dengan segera).
(N.B. Any change of address, employment telephone number must be notified promptly to the IEM)

2. KEDUDUKAN SEMASA
CURRENT POSITION

Majikan: ..................................................................................................................................................................................................................
Employer

Alamat: ...................................................................................................................................................................................................................
Address

...............................................................................................................................................................................................................................

Jawatan: ......................................................................................

Tarikh Perlantikan: .......................................................................................

Position

Date of Appointment

Nama Jurutera Yang Bertanggungjawab/Jawatan: ......................................................................................................................................................

Name of Engineer responsible to/Position

No. Ahli IJM (Jika ada) .. Disiplin:

IEM Membership No. (if any)

Discipline

3. BAYARAN
PAYMENT

SAYA SERTAKAN YURAN SEBANYAK RM235

CEK

WANG POS

I TENDER HEREWITH THE FEE OF RM235

CHEQUE

POSTAL ORDER

TUNAI
CASH

Implementation Date: August 2013

4. KENYATAAN OLEH PENCADANG DAN PENYOKONG

STATEMENT BY THE PROPOSER AND SECONDER

(Pencadang dan Penyokong diminta mengesahkan kenyataan Pemohon berdasarkan maklumat yang ada berkenaan Pemohon)
(Proposer and Seconder are requested the Applicant's statements based on their personal knowledge)

SETELAH mengenali pemohon selama ................... tahun; setakat pengetahuan saya dalam semua aspek, saya mengesyorkan beliau adalah
layak dilantik sebagai Companion Institusi ini.
HAVING known the applicant for ................. years, I recommend him, from personal knowledge, as in every respect, worthy of the distinction of being elected as Companion
of the Institution.

NAMA PENCADANG: ....................................................................................................................................................................................

NAME OF PROPOSER

Gred: Ahli Fellow / Ahli: .....................................................................

No. Ahli: ........................................... Disiplin : .............................

Grade: Fellow / Member

Membership No.

Discipline

Alamat : ....................................................................................................................................................................................................... .
Address :

............................................................................................................................. ...........................................................................................
Tandatangan: ......................................................................................

Tarikh: ...........................................................................................

Signature

Date

NAMA PENYOKONG: ............................................................................................................................. ....................................................

NAME OF SECONDER

Gred: Ahli Fellow / Ahli: ...................................................................... No. Ahli: ........................................... Disiplin : .............................
Grade: Fellow / Member

Membership No.

Discipline

Alamat : ..................................................................................................................................................................... ...................................

Address :

............................................................................................................................................................ ............................................................
Tandatangan: ......................................................................................

Tarikh: ...........................................................................................

Signature

Date

(Nota: Salah seorang daripada Ahli Korporat di atas mestilah Ahli Fellow atau Ahli Korporat yang telah menjadi Ahli tidak kurang daripada
10 tahun). Kami, Ahli Korporat yang menandatangani di atas sependapat dengan cadangan ini berdasarkan pengetahuan diri masingmasing.
(NOTE: One of the above Corporate Members must be a FELLOW or a Corporate Member of not less than 10 years standing with the Institution). We, the above signed
Corporate members concur with the above recommendation from personal knowledge.

5.

PENGAKUAN (sila baca dengan teliti)

DECLARATION (Please read carefully)

Saya, yang bertandatangan di bawah, berjanji bahawa sekiranya diterima sebagai Companion IJM, saya akan mematuhi Perlembagaan,
Undang-Undang dan Peraturan-Peraturan Institusi pada masa ianya dikuatkuasakan dan saya akan menerima sebagai muktamad segala
keputusan Majlis terhadap semua perkara yang dilakukan oleh Majlis setaraf dengan peruntukan Perlembagaan, Undang-Undang dan
Peraturan-Peraturan;
I, the undersigned, do hereby promise that, in the event of my transfer to the grade of Companion, I will be governed by the Constitution, By-Laws and Regulations of the Institution for
the time being in force, and that I will accept as final and binding the decisions of the Council on all matters dealt with by them in accordance with the Provisions of the said
Constitution, By-Laws and Regulation;

Saya berjanji akan meningkatkan objektif Institusi mengikut seberapa daya yang boleh, melainkan apabila saya menulis kepada Setiausaha
Kehormat bahawa saya akan mengundurkan diri sebagai Ahli Institusi dan saya akan dibebaskan daripada tanggungjawab ini selepas
menjelaskan segala hutang tunggakan yuran kepada IJM. Saya bertanggungjawab terhadap ketepatan butiran yang terkandung dalam borang
permohonan ini. Saya setuju membuat sumbangan yang munasabah kepada Tabung Perpustakaan, dan sepanjang kerjaya Profesional saya, saya
akan cuba mengemukakan kepada Institusi ini penerbitan yang sesuai.
I further undertake that I will promote the objects of the Institution as far as may be in my power; provided that whenever I shall signify in writing to the Secretary that I am
desirous of withdrawing from the Institution, I shall after the payment of any arrears, which may be due from me at the period, be free from this obligation. I accept
responsibility for the accuracy of the particulars contained in this application form and agree that if I am elected the validity of my election shall depend upon the accuracy of
such particulars as required by the By-Laws. I will make an acceptable donation to the Library Fund, and in course of my professional career I will endeavour to present to the
Institution an original communication or communication relating to engineering science or practice.

Saya mengakui bahawa sekiranya kelayakan saya didapati tidak sejajar dengan keperluan syarat kemasukan Institusi disebabkan perubahan
polisi atau kesilapan semasa penerimaan kemasukan sebagai Ahli, maka Institusi berhak menarik balik status keahlian saya.
I hereby acknowledge that in the event my qualifications are found to be non-compliant to the Admission criteria of the Institution due to changes in policies or oversight at the
time of admission the Institution reserves the right to withdraw my membership

Tarikh: ................................................................
Date

Tandatangan Pemohon: ............................................................

Signature of Applicant

NOTA: IJM tidak bertanggungjawab keatas kehilangan atau kerosakan sebarang dokumen-dokumen ASAL yang dihantar bersama permohonan ini.
NOTE: IEM is not responsible for the loss of, or damage to, any ORIGINAL document forwarded with this application

Implementation Date: August 2013