FORM H

FORM H

REGISTRATION OF ENGINEERS ACT 1967 (REVISED 2015)

APPLICATION FOR RENEWAL OF REGISTRATION FOR YEAR ...........
Regulation 20 of the Registration of Engineers Regulations 1990 (Revised 2015)

A. APPLICATION FOR RENEWAL OF REGISTRATION FOR :

* * Professional Engineer with Practicing

Professional Engineer
Certificate

* *
Inspector of Works Accredited Checkers

Tick ( ) where applicable

B. APPLICANT'S DETAIL (To be completed by the applicant in BLOCK LETTERS)

1. Name : .........

2. Identity Card No. / Passport : ................................................................ Nationality: ......................................

3. Registration No. : .........

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4. Address (if any changes) :
Please refer to sections 14 and 25 (1) of the Registration of Engineers Act 1967 (Revised 2015)

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5. Tel No. : ........................................................................ Mobile Phone No. : .....................................................

6. E - mail : ..................................................................................... Fax No. : ..................... ...................................

7. Payable to " BOARD OF ENGINEERS MALAYSIA" . Payment details :

** Bank draft / cheque / *** Money Order / Postal Order No. . .............................. RM ...................................

** Payment " online " via bank ........................................amounting to ....................... on ................................

C. DECLARATION

I declare that I am * Not a bankrupt * declared a bankrupt

D. PASSPORT SIZE PHOTOGRAPH

I have reviewed my Registration Record on the website www.bem.org.my and confirm :

* Complete with photograph * (i) Record with no photograph

(ii) Photograph attached with ** FORM H / Email

E. CPD RECORD for the last three years

CPD Hours for ..... CPD Hours for ..... CPD Hours for .....
 FORM H

Total No. of CPD Hours for the last 3 years =

I hereby declare that the information and particulars provided by me on the above form is true and correct.

..... .........
(Signature of Applicant) Date

* Please ( ) where applicable ** Delete if not applicable *** Money Order / Postal Order Malaysia only accepted.
 FORM H

FORM H

CHECKLIST
(To be submitted together with Form H)
For Office
Applicant
Use

1. Form H have been duly filled and signed.

2. CPD Record for the last three (3) years.

3. Photograph (if applicable).

4. Payment by Cheque:

(a) Payable to Lembaga Jurutera Malaysia

(b) Same amount and figure
(c) Valid Bank Account and Signature
(d) Valid date month/year
(f) No correction made on cheque

Remarks :
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I confirm that I have completed the above and fulfil BEM For Office Use Only
requirements.
Signature of Officer-in-charge
Board of Engineers Malaysia

........................................................................................
(Signature of Applicant)
Date :
.....................................................................
Date :