Distributor Online Application

Registration Application

Fields Indicated with * are Compulsory

Category *

PRP

IPRA

CPRA

Particulars of Applicant

Company Name *

Date of Incorporation *

Co. Reg. No. *

Registered Address *

Registered Postcode *

Registered State *

Registered Tel. No. *

Eg: 603XXXXXXXX

Registered Fax No. *

Eg: 603XXXXXXXX

Correspondence *

Same as above Yes No

Correspondence Address *



Correspondence Postcode *
Correspondence State *
Correspondence Tel. No. *	Eg: 603XXXXXXXX
Correspondence Fax No. *	Eg: 603XXXXXXXX

Website *

Type of Ownership *

M'sian Bumi Controlled Company	M'sian Non-Bumi Controlled Company
Foreign Controlled Company	Others

Nature of Business *

Paid Up Capital *

Authorised Representative Details

Name of Authorised Person *

Designation *

Department *

I.C No./ Passport No. *

New NRIC Old NRIC Passport

Tel. No. *

Eg: 603XXXXXXXX

Fax No. *

Eg: 603XXXXXXXX

Email Address *

A. Authorised Representative

Member Id *

Password *

Confirm Password *

Contact Person Details

A. Contact Person 1

Name of Contact Person 1*

Designation *

Department *

I.C No./ Passport No. *

New NRIC Old NRIC Passport

Tel. No. *

Eg: 603XXXXXXXX

Fax No. *

Eg: 603XXXXXXXX

Email Address *

B. Contact Person 2

Name of Contact Person 2 *

Designation *

Department *

I.C No./ Passport No. *

New NRIC Old NRIC Passport

Tel. No. *

Eg: 603XXXXXXXX

Fax No. *

Eg: 603XXXXXXXX

Email Address *

We agree to abide by the applicable Terms and Conditions of use for this system and relevant laws and rules issued by FIMM.

We hereby confirm that the information given herein and in any other document provided by us for purposes of our application and registration with FIMM is true and accurate.

Further, we hereby confirm and under take to ensure that, pursuant to the Personal Data Protection Act 2010, we have the consent of our officers, employees and private retirement scheme consultants for the disclosure to and use by FIMM of their personal data.

Registration Application (Documents Checklist)

	No	Document
	1	Latest Form 8 Or 9, Form 13, Form 24 and Form 49 certified true copy by the Company Secretary
	2	Certified True Copy of relevant CMSL and approval that verify the eligibility of the applicant
	3	Board of Directors’ Resolution approving the appointment of the authorized representative(s).
	4	Cover letter signed by the Authorised Representative ("AR") specifying the registration that is being sought. If the AR appointed for the registration as PRS Provider is not the same as the AR appointed for the registration as UTMC, the cover letter shall be signed by an authorised signatory specifying the registration that is being sought and the appointment of AR
	5	Declaration signed by a director of the applicant
	6	Proposal for the marketing and distribution of PRS
	7	Payment for the application and annual fees
	8	Printed Online Application

*Note: FIMM may request for additional information/documentation in relation to any such matters.*

Distribution Points

NUMBER OF PROPOSED DISTRIBUTION POINTS INVOLVED IN THE MARKETING AND DISTRIBUTION OF PRIVATE RETIREMENT SCHEME IN THIS APPLICATION

(a) Proposed Distribution Points *

(b) Proposed Mobile Distribution Sites *

PRS Consultants

No. of proposed PRS Consultants

Minimum 2 PRS Consultants at each Distribution Point(s) and Mobile Distribution Site(s)

Payment Information

Existing UTMC/IUTA/CUTA

Yes No

A. Application Fee Payment

Bank Name

Cheque Number

Minimum 6 and Maximum 6 characters required.

Amount (including 6 % GST)

B. Annual Fee Payment

Bank Name

Cheque Number

Minimum 6 and Maximum 6 characters required.

Amount (including 6 % GST)