(Note (*) All prices include GST)

Participants must submit the Registration and full paymentof fees before course commencement.

Registration form submitted without the correspondingregistration fees will not be processed. Seats will beguaranteed only on prior registration with full payment.

All fees must be made payable in advance to“UPM Education & Training Sdn. Bhd.”

Bank Detail:CIMB Bank BerhadBranch of Universiti Putra Malaysia43400 UPM Serdang, Selangor.A/C No. 8002167906

Please contact the Secretariat for further information:

Malaysian Fire Protection AssociationNo. 25-4, Block HJalan PJU 1/37, Dataran Prima47301 Petaling JayaSelangor Darul Ehsan.Tel.:03-78049141 Fax: 03-78044592Email: office@mfpa.com.my

UPM Education & Training Sdn. Bhd.Training UnitBlock D, UPM-MTDC Technology CentreUniversiti Putra Malaysia43400 SerdangSelangor Darul Ehsan.Phone No. : 03.8959.3408Fax No. : 03.8959.3409Email : upmet.training@gmail.com

Programme RM √1 Fire Extinguisher Course

(Theory & Practical)700/pax*

2 Examination Theory &Practical

318/pax*

Company Name : ..........................................................................

Address : ..........................................................................

...........................................................................................................

Office No. :............................... .. HP No.:..........................................

Fax. No. : .............................. ... Email :...........................................

Participants

Please specify preferred date of session and location

Total Registration Fees:Cheque No./Receipt No. .............................................enclosed forthe sum of RM......................................being registration fees forthe course.

I/We understand that my/our registration is subjected to thefollowing conditions:

1. The fees are not refundable. However substitution ofparticipant will be accepted prior to notice (1 week beforetraining) in writing.

2. Registration is only accepted upon full payment of fee 2 weekbefore the training.

3. The organizer reserve the right to postpone/cancel the trainingor change the programme without prior notice.

4. Certificates will be issued only within two weeks after theprogramme.

No Name I/C No. HP

Programme Session Date

Fire Extinguisher Course 2017

Examination (Theory & Practical)

Mandate by :

FIRE & RESCUE DEPARTMENT MALAYSIA

Supported by :

MALAYSIAN FIRE PROTECTION ASSOCIATION

UPMHOLDINGSUPM Education & Training Sdn. Bhd.

GST NO :002005909504

FIRE EXTINGUISHERCOMPETENT PERSON

COURSE2017

REGISTRATION & PAYMENT REGISTRATION FORM

To ensure that each participant has the competency in the selec-tion, installation, servicing and maintenance of portable fire extin-guisher and qualified to be registered as a competent person in theeFEIS with Fire And Rescue Department Malaysia (FRDM).

Requirement for Fire Extinguisher Course

Age between 18 - 65 years old

Physically & mentally fit

Participants must bring their own safety equipments (goggle,mask, glove, safety boot)

Requirement for application of Competency Examination

A Malaysian Citizen

Age between 18 - 65 years old

Minimum educational qualification—Pass SPM or equivalent

Has attended Fire Extinguisher Course.

Physically & mentally fit

Possess two (2) years working experience in servicing portablefire extinguisher

Possess sufficient knowledge and skill in servicing of portablefire extinguisher.

Participants must bring their own safety equipments (goggle,face mask, glove & safety boot)

Participants must bring the following documents forverification purposes:

1. Identity card;2. SPM certificate or equivalent;3. Certificate of Registration of Employer (KWSP 19) /

latest three (3) months EPF contribution by theemployer, Latest two (2) years EPF Member’s AccountStatement OR Latest two (2) years SOCSO Statement

Candidates who failed in the examination (theory and/orpractical) will be allowed to repeat the examination within two(2) years .

Day 1

08:30—09:00 Registration09:00—10:00 Introduction to Portable Fire Extinguishers

PM. Ir. Dr. Nor Mariah Adam (UPM)10:00—10:30 Break10:30—12:30 Electronic Fire Extinguisher Inspection System

(eFEIS)Fire and Rescue Department Malaysia (FRDM)

12:30—14:30 Break14:30—15:30 Specifications for Portable Fire Extinguishers

Malaysian Fire Protection Association (MFPA)15:30—17:30 Maintenance of Portable Fire Extinguishers

(MS 1539: Part 4:2004)Malaysian Fire Protection Association (MFPA)

17:30 End of First Day

Day 2

08:15—08:30 Registration08:30—12:30 Servicing and Maintenance of Portable Fire

Extinguishers (Practical)Malaysian Fire Protection Association (MFPA)

12:30—14:00 Break14:00—17:30 Practical Session17:30—18:00 End of Second Day

Examination Day

08:00—08:15 Registration08:15—08:30 Briefing for Examination (Theory and Practical)08:30—09:30 Examination (Theory)09:30—10:30 Break10:30—13:00 Examination (Practical)13:00—14:00 Break14:00 – 18:00 Examination (Practical)18:00 End of Session

SEMINAR

* Please note there is a minimum requirement of 40 participantsregistered per session in order for the class to run. If the mini-mum number of required participants is not met for a specificdate those registered will be automatically added to the nextavailable course date.

EXAMINATION

* Please note there is a minimum requirement of 40 participantsregistered per session in order for the exams to run. If theminimum number of required participants is not met for aspecific date those registered will be automatically added to thenext available course date.

Kindly browse through our website for further informationhttp://www.upmet.upm.edu.my/kursus

OBJECTIVE TENTATIVE PROGRAMME

SESSIONNO

SESSION DATE LOCATION

1. 03-04 MAR 2017 UPM

2. 21-22 APR 2017 UPM

3. 21-22 JUL 2017 UPM

4. 8-9 SEPT 2017 UPM

5. 17-18 NOV 2017 UPM

6. 15-16 DEC 2017 UPM

SCHEDULE 2017

SESSIONNO

SESSION DATE LOCATION

1. 05 MAR 2017 UPM

2. 23 APR 2017 UPM

3. 23 JUL 2017 UPM

4. 10 SEPT 2017 UPM

5. 19 NOV 2017 UPM

6. 17 DEC 2017 UPM

UPMHOLDINGSUPM Education & Training Sdn. Bhd.

Syarat - syarat KursusFire Extinguisher Competent Person

Peserta perlu mempunyai kelayakan akademiksekurang-kurangnya lulus Sijil PelajaranMalaysia (SPM) dan setaraf atau kelayakanyang lebih tinggi seperti sijil program pengajianyang diiktiraf (Diploma/Ijazah) serta membawasijil asal semasa sesi pendaftaran.

Peserta perlu mahir dan mempunyaipengalaman bekerja sekurang-kurangnya dua(2) tahun berkaitan dengan kerja-kerjapenyelenggaraan alat pemadam api mudahalih. Kriteria pengalaman bekerja adalah suatuyang subjektif dan pihak kami tidak meletakkansebarang pengukuran dan penilaian terhadappengalaman tersebut. Ianya perlu ditafsirkansendiri oleh syarikat dan peserta yang terlibat.Peserta perlu melampirkan salinan PenyataAhli KWSP untuk 2 tahun yang terkini danPenyata Caruman Majikan 3 bulan terakhir /Sijil Pendaftaran KWSP (KWSP 19).

Sekiranya peserta masih ingin mengikuti kursusini walaupun tidak mahir dan tidakmempunyai pengalaman bekerja yangmencukupi, pihak syarikat dan peserta perlumenanggung risiko sendiri sekiranya pesertagagal dalam ujian teori atau ujian praktikal.Selain itu, peserta juga mungkin menghadapimasalah untuk berdaftar sebagai "CompetentPerson" dengan JBPM yang meletakkankriteria berpengalaman dalampenyelenggaraan APA sebagai satu syaratpenilaian. Pihak kami tidak akanbertanggungjawab sekiranya peserta tidaklayak untuk berdaftar sebagai ‘CompetentPerson ‘dengan JBPM.

Umur peserta yang dibenarkan untukmengikuti kursus ini adalah 18 hingga 65tahun sahaja dan sihat tubuh badan.Sekiranya umur peserta melebihi 65tahun, peserta perlulah mendapatpengesahan daripada PegawaiPerubatan Kerajaan yang mengesahkanbahawa tuan/puan berada dalamkeadaan sihat dan mampu untukmelakukan kerja berat.

Para peserta perlulah boleh membacadan menulis di dalam Bahasa Melayuatau Bahasa Inggeris bagi mengikutikursus dan ujian yang akan dilaksanakan.

Para peserta mestilah mempunyaiperalatan asas keselamatan yang perludibawa sebagai alat perlindungankeselamatan diri seperti "safety shoes","goggle", "mask" dan "gloves" semasakursus dijalankan.

Yuran bagi mengikuti kursus ini ialahRM700.00 (termasuk GST) danRM318.00 untuk mengambilpeperiksaan .

Sekiranya peserta gagal dalam ujianyang dijalankan, para peserta perlumengulang (repeat) ujian tersebut padasiri kursus yang akan datang. Yuran bagiujian ulangan adalah RM106 (UjianTeori) dan RM212 (Ujian Praktikal).Ujian ulangan akan dilaksanakan padahari peperiksaan yang akan datang.

Saya memahami dan bersetuju dengansyarat -syarat yang telah ditetapkan bagimengikuti kursus di atas. Sekiranya sayamelanggar peraturan dan terma yangtelah ditetapkan maka pihak UPMEducation & Training Sdn. Bhd. bolehmembatalkan penyertaan dan tidakperlu memulangkan yuran yang telahdibayar. Sebarang perkara yang berlakumelibatkan kesihatan saya sewaktumenghadiri kursus dan menjalani ujianteori serta praktikal adalah dibawahrisiko dan tanggungan sendiri.

Tandatangan Peserta

_____________________________

Nama :

No. K/P :

Tarikh :

Cop Syarikat :