KnowledgeCentre@Bursa

INDIVIDUAL MEMBERSHIP APPLICATION / RENEWAL FORM

New membership or Renewal Full Name (Mr./ Ms./ Mrs./ Dr.): Male Female New NRIC No : Email :

Home Address :

Profession/Occupation : Company :

Telephone - (Home) : (Mobile) : (Office) :

Subject(s) of Interest :

Do you wish to receive a Tax Invoice? Yes No

Note: Membership fee : RM 106 per annum* Book Deposit : RM 200 (2 books for two weeks)** Photographs : 2 pieces (passport size)

*Inclusive of 6% Goods and Services Tax (“GST”) **Book deposit will be refunded within 6 months upon expiry date of the membership. The original receipt is required for the refund process.

i. I confirm that all particulars stated in this form are correct as at the date of this form. ii. I hereby declare that the information sourced from KnowledgeCentre@Bursa will be utilised only for my own research and

will not be sold/transferred/given to anyone.

iii. I have read and understood the Personal Data Protection Notice attached to this form and consent to the processing of my

personal data.

Applicant Signature

YOUR PHOTO

HERE

For 1st time

application only

This portion for office use only

Membership No

:

Member since

Expiry Date

: :

Membership Fee Receipt No Book Deposit Receipt No

: : : :

Issued by (Staff Name & signature) Approved by (Head of Department)

:

Name: :

Name:

Personal Data Protection Notice

1. This written notice serves to inform you that your personal data is being collected, recorded, held and stored

(“Processed”) by Bursa Malaysia Berhad.

2. The personal data Processed by us is your name, photograph, identity card number, home address,

profession/occupation, company name and telephone number.

3. We are Processing your personal data, including any additional information you may subsequently provide, for

KnowledgeCentre@Bursa membership related purposes (“Purposes”).

4. You may access and request for correction of your personal data and contact us with any enquiries or

complaints in respect of your personal data by contacting us using the following contact details:

Designated Contact Person:

Hazly Mohd Din

Mailing address:

Bursa Malaysia Berhad, Knowledge Centre, Exchange Square Annexe, Bukit Kewangan, 50200 Kuala Lumpur, Malaysia.

Telephone No.:

03 2034 7481

Fax No.:

03 2026 3697

E-mail address:

knowledgecentre@bursamalaysia.com

5. Your personal data may be disclosed to our parent company, subsidiaries, related and/or associated companies

and/or service providers for the above Purposes or any other purpose for which your personal data was to be

disclosed at the time of its collection or any other purpose directly related to the above Purposes.

6. It is obligatory that you supply us with the personal data as requested.

7. If you fail to supply to us the above personal data, we may not be able to carry out the Purposes for which you

have provided us the personal data.

8. By providing us your personal data in the Individual Membership Application/ Renewal Form or in any other

manner, you consent to the Processing of your personal data in accordance with all of the forgoing.

Notis Perlindungan Data Peribadi

1. Notis bertulis in bertujuan memaklumkan anda bahawa data peribadi anda dikumpul, direkodkan, dipegang dan

disimpan (“diproses”) oleh Bursa Malaysia Berhad.

2. Data peribadi anda yang diproses oleh kami adalah nama, gambar, nombor kad pengenalan, alamat residensi,

profesion/pekerjaan, nama syarikat dan nombor telefon.

3. Data peribadi anda yang diproses oleh kami, termasuk apa-apa maklumat tambahan yang mungkin anda

bekalkan kepada kami kemudian, adalah untuk tujuan berkaitan dengan keahlian KnowledgeCentre@Bursa

(“Tujuan”).

4. Anda boleh mengakses dan memohon untuk pembetulan terhadap data peribadi anda dan menghubungi kami

dengan apa-apa pertanyaan atau aduan berkenaan data peribadi anda melalui pos, telefon faks atau e-mail

seperti berikut:

Pegawai yang boleh dihubungi:

Hazly Mohd Din

Alamat Surat-menyurat :

Bursa Malaysia Berhad, Knowledge Centre, Exchange Square Annexe, Bukit Kewangan, 50200 Kuala Lumpur, Malaysia.

No Telefon.:

03 2034 7481

No. Faks:

03 2026 3697

Alamat E-mel :

knowledgecentre@bursamalaysia.com

5. Data peribadi anda boleh dizahirkan kepada syarikat induk kami, anak-anak syarikat, syarikat-syarikat berkaitan

dan/atau sekutu, dan/atau pemberi-pemberi khidmat, untuk Tujuan yang dinyatakan di atas atau apa-apa tujuan

lain yang berhubungan secara langsung dengan Tujuan yang dinyatakan di atas.

6. Adalah wajib untuk anda membekalkan kami dengan data peribadi yang diminta oleh kami.

7. Sekiranya anda gagal untuk membekalkan kami dengan data peribadi anda, kami mungkin tidak dapat

memproses data peribadi anda bagi Tujuan yang dinyatakan di atas.

8. Dengan membekalkan data peribadi anda melalui boring permohonan/pembaharuan keahlian atau melalui

apa-apa cara lain, anda membenarkan data peribadi anda diproses selaras dengan segala yang dinyatakan di

atas.