MII Team Of Experts - Application Form

The Malaysian Insurance Institute - MII Team of Experts

Application Form
Please email certified photocopies of certificates, passport size photo and other relevant supporting documents to: En. Mohamed Fuzi (mdfuzi@mii.org.my) or Ms. Lina Tan (lina@mii.org.my)

Section A : Personal Details

Name

New I.C. Number

Gender

Race

Nationality

Marital Status

Correspondence Address

Employer's Name

Employer's Address

Tel. No. (office)

Tel. No. (residence)

Mobile No.

Fax No.

Section B : Professional Details

Educational Background

Academic / Professional Qualifications (Please email certified copies of qualifications acquired)

Year	Qualification	Name of Institution	Title / Degree Awarded (Abbreviations only)

Work Experience

Year (e.g. 1990-2000)	Company	Designation

Section C : Other Information

Past and Present Affiliations / Membership

Year (e.g. 1990-2000)	Name of Organisation / Institution

Contributions / Awards / Achievements

Section D : Team Involvement

Preferred area(s) of work with MII (you may tick more than once)

	No Experience	Little Experience	Some Experience	Experienced	Very Experienced
Training/Lecturing
Course/Material Development
Book Writing
Exam Question-Setting
Exam Moderation
Editing of Texts/Materials
Translation of Texts/Materials
Other MII Projects

Areas of Expertise

Please indicate the subject areas, e.g. Insurance, Law, Financial Planning, etc., that you plan to be involved with, and your language proficiency

Subject Areas	Language Proficiency (Tick where appropriate)
Subject Areas	English	BM	Mandarin

Preferred Team Involvement

Full Time (Expected Salary : )

Part Time

Please state experience related to the area(s) of work that you have indicated above.

Year (e.g. 1990-2000)	Organisation / Institution	Details of Experience

Are you prepared to undergo any training as may be required for the area(s) you have indicated?

Yes

Section E : Declaration

I declare that to the best of my knowledge the information supplied in this application form and the supporting documents are correct and complete. If my application is successful, I agree to abide by all the rules and regulations of the Institute.

For any enquiries, please contact En.Mohamed Fuzi or Ms.Lina Tan at or tel: 03-2087 8882 ext. 310 / 420