Submit ID Pool Application

To apply to the Independent Directors Pool, please provide the information requested below.

Please note that all individuals who wish to be considered for inclusion in the ID Pool must meet the following criteria:

  1. Be above 40 and below 75 years of age.
  2. Have at least 10 years of work experience in a managerial position, preferably in a multi-national company (MNC), public-listed company (PLC), or the public service.
  3. Hold a degree or professional-based qualification.

All applications must be accompanied by a non-refundable administrative fee of RM200. Cheques are to be made payable to "Badan Pengawas Pemegang Saham Minority Berhad".

You will be contacted by MSWG and provided with additional information once your application has been received and reviewed.

If you would prefer to submit your application offline, please download the Independent Directors Pool Application (PDF format), and return the completed form to us with copies of your supporting documents and the administrative fee.

If you have any questions or concerns regarding the IDP application process, please contact the MSWG office by phone at 603 2070 9090 or by email at watchdog@mswg.org.my.

A. PERSONAL PARTICULARS
Title :
First Name :
Last Name :
Preferred Name :
Gender :
Old I/C No. :
New I/C No. / Passport No. : (IC without '-')
Nationality :
Date of Birth :
Place of Birth :
Marital Status :
Religion :
Race :
 
Permanent Address 1 (house) :
Permanent Address 2 (house) :
Permanent Address 3 (house) :
Permanent Postcode (house) :
Permanent City (house) :
Permanent Country (house) :
Permanent State (house) :
Permanent State (house) :
Tel No. : (House)
  : (Mobile)
Fax No. :
 
Correspondence Address 1 (mailing) :
Correspondence Address 2 (mailing) :
Correspondence Address 3 (mailing) :
Correspondence Postcode (mailing) :
Correspondence City (mailing) :
Correspondence Country (mailing) :
Correspondence State (mailing) :
Correspondence State (mailing) :
Tel No. : (House)
  : (Office)
E-mail :
Photo (optional) :  (Image file size not exceed 20MB)
Resume (optional) :  (File size not exceed 20MB)
Sector :  
Profession :  
 
B. FAMILY PARTICULARS
Title of Spouse :
Spouse First Name :
Spouse Last Name :
Old I/C No. :
New I/C No. / PassportNo. : (IC without '-')
Nationality :
Date of Birth :
Race :
Religion :
Name of Employer :
Employer Address 1 :
Employer Address 2 :
Employer Address 3 :
Occupation :
Tel : (Mobile)
  : (Office)
 
Details of Children (if applicable)
1. Title :
First Name :
Last Name :
Gender :
Date of Birth :
 
2. Title :
First Name :
Last Name :
Gender :
Date of Birth :
 
3. Title :
First Name :
Last Name :
Gender :
Date of Birth :
 
4. Title :
First Name :
Last Name :
Gender :
Date of Birth :
 
5. Title :
First Name :
Last Name :
Gender :
Date of Birth :
 
C. HOBBIES AND SPECIAL INTERESTS
Hobbies:
:
Special Interests :
 
D. EDUCATIONAL DETAILS
Name of College / University :
Degree Course :
Qualification :
 
Name of College / University :
Post Graduate Course :
Qualification :
 
Name of College / University :
Professional Qualification :
Qualification :
 
E. PROFESSIONAL MEMBERSHIP
1. Name of Association :
  Date Joined :
  Membership Status / Position Held :
 
2. Name of Association :
  Date Joined :
  Membership Status / Position Held :
 
3. Name of Association :
  Date Joined :
  Membership Status / Position Held :
 
4. Name of Association :
  Date Joined :
  Membership Status / Position Held :
 
5. Name of Association :
  Date Joined :
  Membership Status / Position Held :
 
F. OTHER DIRECTORSHIPS (Current)
1. Name of Companies (Please state whether Public Listed Company / Private Company) :
  * Nature of Directorship :
  Date of Appointment :
 
2. Name of Companies (Please state whether Public Listed Company / Private Company) :
  * Nature of Directorship :
  Date of Appointment :
 
3. Name of Companies (Please state whether Public Listed Company / Private Company) :
  * Nature of Directorship :
  Date of Appointment :
 
4. Name of Companies (Please state whether Public Listed Company / Private Company) :
  * Nature of Directorship :
  Date of Appointment :
 
5. Name of Companies (Please state whether Public Listed Company / Private Company) :
  * Nature of Directorship :
  Date of Appointment :
 
G. OTHER DIRECTORSHIPS (Previous)
1 Name of Companies (Please state whether Public Listed Company / Private Company) :
  * Nature of Directorship :
  Date of Appointment :
  Date of Resignation :
 
2 Name of Companies (Please state whether Public Listed Company / Private Company) :
  * Nature of Directorship :
  Date of Appointment :
  Date of Resignation :
 
3 Name of Companies (Please state whether Public Listed Company / Private Company) :
  * Nature of Directorship :
  Date of Appointment :
  Date of Resignation :
 
4 Name of Companies (Please state whether Public Listed Company / Private Company) :
  * Nature of Directorship :
  Date of Appointment :
  Date of Resignation :
 
5 Name of Companies (Please state whether Public Listed Company / Private Company) :
  * Nature of Directorship :
  Date of Appointment :
  Date of Resignation :
 
H. COURSE / TRAINING ATTENDED
1 Name of Course / Training :
  Organised By :
  Date :
  Duration :
 
2 Name of Course / Training :
  Organised By :
  Date :
  Duration :
 
3 Name of Course / Training :
  Organised By :
  Date :
  Duration :
 
4 Name of Course / Training :
  Organised By :
  Date :
  Duration :
 
5 Name of Course / Training :
  Organised By :
  Date :
  Duration :
 
I. SUMMARY OF KEY AREAS RESPONSIBILITIES & LENGTH OF SERVICE (5 Main Areas)
1 Name of Organisation :
  Position Held :
  From :
  To :
  Total :
  Summary of Responsibilities
 :
 
2 Name of Organisation :
  Position Held :
  From :
  To :
  Total :
  Summary of Responsibilities
 :
 
3 Name of Organisation :
  Position Held :
  From :
  To :
  Total :
  Summary of Responsibilities
 :
 
4 Name of Organisation :
  Position Held :
  From :
  To :
  Total :
  Summary of Responsibilities
 :
 
5 Name of Organisation :
  Position Held :
  From :
  To :
  Total :
  Summary of Responsibilities
 :
 
J. PERSONAL REFERENCES
1. Title :
First Name :
Last Name :
  Address 1 :
  Address 2 :
  Address 3 :
  Tel No. :
  Fax No. :
  E-mail :
  Relationship :
 
2. Title :
First Name :
Last Name :
  Address 1 :
  Address 2 :
  Address 3 :
  Tel No. :
  Fax No. :
  E-mail :
  Relationship :
 
3. Title :
First Name :
Last Name :
  Address 1 :
  Address 2 :
  Address 3 :
  Tel No. :
  Fax No. :
  E-mail :
  Relationship :
 
   
K. DECLARATION
I hereby declare that all the information given in this application form is complete and accurate to the best of my knowledge. Any false or inaccurate information provided or the withholding of any relevant information would subject myself to being withdrawn from the Independent Directors' Pool. I further agree that MSWG may remove me from the Pool at any time for any reason whatsoever in its absolute discretion and without the need to notify me of such reason.
  Note: The Pool only serves as a source from which PLCs can select potential directors. MSWG does not in any way guarantee eventual appointment by any PLCs. MSWG will not be held responsible to the Applicant or any other party for any liabilities, claims, suits, losses, costs and expense (including any legal fees) caused by or arising out of the Applicant being placed in the Pool or any representations, statements or information given by the Applicant.