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7/24/2019 Through Agent Application Form (Complete)
1/19
NO. DOKUMEN PK.(O).KPK.PSA.02 (L1) Pin.1
TARIKH KUATKUASA 11 APRIL 2014
MUKA SURAT 1 daripada 4
MALAYSIA MY SECOND HOME (MM2H) CENTRE
Ministry of Tourism and Culture Malaysia
1
MALAYSIA MY SECOND HOME (MM2H) PROGRAMME
CHECKLIST FOR APPLICATION THROUGH MM2H LICENSED COMPANY
1.
Letter of Application (by the applicant);
o Include information on personal background, intention to join the MM2H Programme, if
joining as a single or with family and briefly explain how applicant will support his/her
stay in Malaysia (financial capabilities)
2. A copy of resume by the main applicant which includes the following information:
o Academic qualification
o Working experience
o Skills or expertise acquired
3. One (1) copy of MM2H Application Form (downloadable from MM2H website)
Note: Form has to be completed individually for main applicant and all dependents.
4. Three (3) copies of IM.12 FormSocial Visit Pass
o One (1) original copy (form is downloadable from MM2H website); and
o Two (2) Photostat copies.
Note: Form has to be completed individually for main applicant and all dependents.
5. Four (4) coloured passport sized photographs (3.5 x 5.0 cm)
6.
Copy of Passport/ Travel documents
o One (1) copy with certification on personal particulars page (all pages)
o
Two (2) copies of personal particulars page
Note : Copy of the previous passport is required if main applicant/dependent(s) has
renewed passport within the last 12 months
7.
Personal Bond
o Personal Bond is to be submitted for main applicant only
o Must be completed and signed by Malaysia who is one of the Board of Directors/
Shareholders/ managing Director/ manager from the appointed MM2H licensed
company.
8.
Letter of Good Conduct from main applicants relevant government agency
For agent use only
Please tick (
)
For official use
Please tick (
)
7/24/2019 Through Agent Application Form (Complete)
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NO. DOKUMEN PK.(O).KPK.PSA.02 (L1) Pin.1
TARIKH KUATKUASA 11 APRIL 2014
MUKA SURAT 2 daripada 4
MALAYSIA MY SECOND HOME (MM2H) CENTRE
Ministry of Tourism and Culture Malaysia
1
9. Self declaration on main applicants/ dependents health conditions Form RB I
(downloadable from MM2H website)
10. Certified copy of Marriage Certificate (if accompanied by spouse)
11. Certified copy of Birth Certificate/ legal documents (if accompanied by children/ adopted
children/ stepchildren/ parents);
o Letter of Confirmation from Medical Specialist/ General Practitioner (if accompanied by
children aged 21 years and above with disabilities).
o Statutory Declaration by main applicant to bear all expenses and financial requirements
during stay in Malaysia for dependents.
o Legal custody documents (for sole custody) and letter of authorization from other parent
(for divorced parents accompanied by children)
12. Certified Copy(s) of latest 3 months bank statement/ other related financial document(s) to
indicate the financial capability to support stay in Malaysia;
13. Certified copies of latest 3 months payslip/ income statement (if employed/pension slip)
o The MM2H Centre would like to inform that effective 12 July 2012, all MM2H
applications must submit bank account statements that shows the latest 3 months
deposit for monthly income (either from salary/ rental/ interest earned/ shares) or
government pensions into the applicants bank accounts
14.
Financial Authorization Letter; to verify the financial documents with the relevant financial
Institutions (downloadable from MM2H website)
For agent use only
Please tick ()
For official use
Please tick ()
7/24/2019 Through Agent Application Form (Complete)
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NO. DOKUMEN PK.(O).KPK.PSA.02 (L1) Pin.1
TARIKH KUATKUASA 11 APRIL 2014
MUKA SURAT 3 daripada 4
MALAYSIA MY SECOND HOME (MM2H) CENTRE
Ministry of Tourism and Culture Malaysia
1
IMPORTANT NOTES:
o All copies must be certified TRUE COPIES OF ORIGINAL DOCUMNTS by EMBASSY/ HIGH COMMISSION/
NOTARY PUBLIC andCOMMISSIONER OF OATHS REGISTERED IN MALAYSIA/ GOVERNMENT OFFICIAL.
o Where original documents are not in ENGLISH, translation must be done by a qualified translator and
CERTIFIED.
o Dependent(s) refer to:
o Spouse
o Children aged below 21 years (maximum 6 months before reaching 21 years old at time of
application) and not married; and
o Parent(s) of main applicant aged 60 years and above.
o Application to include parent(s) as dependents is to be submitted AFTER main applicants application has
been approved.
o
All documents enclosed with the present application become the property of the Malaysia My Second Home(MM2H) Centre and will not be returned.
For APPROVED Participants:
o For dependents added after application has been approved, Personal Bond has to be submitted for each
dependent.
o The Personal Bond Form must be stamped (RM10.00) by the Stamping Office in Inland Revenue Board of
Malaysia
o The amount chargeable is according to Country of Origin of the applicant/ participant. Please refer to Rate of
Security/ Personal Bond by Country.
7/24/2019 Through Agent Application Form (Complete)
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NO. DOKUMEN PK.O).KPK.PSA.02(L1)Pin.1
TARIKH KUATKUASA 11 APRIL 2014
MUKA SURAT 4 daripada 4
MALAYSIA MY SECOND HOME (MM2H) CENTRE
Ministry of Tourism and Culture Malaysia
4
APPLICATION CHECKLIST FOR MALAYSIA MY SECOND HOME (MM2H) PROGRAMME
- REQUIRED DOCUMENTS FROM APPOINTED MM2H LICENSED COMPANY
1.
Surat iringan daripada Syarikat Berlesen MM2H;
Cover letter from MM2H licensed company
Note : Licensed Company is required to summarize all financial information provided by
applicant in the cover letter
2. Salinan lessen syarikat berlesen MM2H yang masih sah tempoh
One (1) copy of companys Mm2H license which is still valid
3.
Surat pengesahan wakil sebagai pekerja di bawah Syarikat Berlesen MM2H
Letter of confirmation on employment of representative under the MM2H Licensed Company
o Submissions of application by employees of the MM2H Licensed Company other than
Managing Director/ Manager has to be included with the above letter confirming
employment of that person.
4. Salinan kad pengenalan Lembaga Pengarah/ Pemegang Saham/ Pengarah Urusan/ Pengurus
yang menandatangani Bon Peribadi.
One (1) copy of the MyKad of Board of Director/ Shareholder/ Managing Director/ Manager
who signed the Personal Bond.
5. Borang kenyataan Penaja (perlu dilengkapkan oleh syarikat berlesen MM2H)
Sponsor Declaration Form (must be completed by MM2H licensed company)
6.
Surat pengesahan daripada Bahagian Pelesenan Pelancongan, Kementerian Pelancongan
Dan Kebudayan Malaysia sekiranya tidak dapat mengemukakan lessen syarikat (jika syarikat
masih dalam permohonan pembaharuan lesen atau perubahan syarat lesen).
Letter of Confirmation from Tourism Licensing Division, Ministry of Tourism and Culture
Malaysia if the MM2H license is not available (due to renewal or change of companys
particulars)
o It is important that the appointed MM2H licensed company advises the client to fill out all
the sections in the application form and include all relevant documents, as incomplete
documentations/ false information will result in the application being rejected.
For agent use only
Please tick ()
For official use
Please tick ()
7/24/2019 Through Agent Application Form (Complete)
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NO. DOKUMEN PK.(O).KPK.PSA.02 (L10) Pin.1
TARIKH KUATKUASA 11 APRIL 2014
MUKA SURAT 1 daripada 5
FOR INDIVIDUAL APPLICANT / SPOUSE (THROUGH MM2H LICENSED COMPANY) v1.2
1
MINISTRY OF TOURISM AND CULTURE MALAYSIAMalaysia My Second Home CentreTelephone: +603 88917424 Fax: +603 88917414
APPLICATION FORM FOR THE MALAYSIA MY SECOND HOME PROGRAMME
A. GENERAL
Please tick for applied category:
50 Years And Above Below 50 Years
Please tick if applicant is accompanied by
Spouse Children
Please tick location of stay
Peninsular Malaysia Sabah Sarawak
For the age category 50 years and above only, please specify preferred financial requirement (if application is
approved):
Fixed Deposit of RM150,000 Monthly government pension of RM10,000
B. PARTICULARS OF APPLICANT
1. Full Name (Capital Letters)
2. Please tick () Gender Male Female
Ex-Malaysian Malaysian I/C :
3. Marital Status [Please tick ()] Single Married Divorced Widow/ Widower
Other Please Specify:
4. Place of Birth (Country)
5. Date of Birth (dd/mm/yyyy) / /
6. Nationality
Passport-sized
Photograph of
Applicant (coloured)
(3.5 x 5.0 cm)
3 pieces
7/24/2019 Through Agent Application Form (Complete)
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NO. DOKUMEN PK.(O).KPK.PSA.02 (L10) Pin.1
TARIKH KUATKUASA 11 APRIL 2014
MUKA SURAT 2 daripada 5
FOR INDIVIDUAL APPLICANT / SPOUSE (THROUGH MM2H LICENSED COMPANY) v1.2
2
7. Passport Number
8. Date of Expiry (dd/mm/yyyy) / /
9. Permanent Address
10. Mailing Address
11. E-mail Address (if any)
Country Code Area Code Number
12. Telephone Number 1) - -
2) - -
I) If currently employed (Q13Q16):
13. Current Employment
14. Income (Per Annum)
15. Current Employer/
Organisation
16. Employers Address
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NO. DOKUMEN PK.(O).KPK.PSA.02 (L10) Pin.1
TARIKH KUATKUASA 11 APRIL 2014
MUKA SURAT 3 daripada 5
FOR INDIVIDUAL APPLICANT / SPOUSE (THROUGH MM2H LICENSED COMPANY) v1.2
3
II) If retired (Q1720):
17. Last employment
18. Pension Received
(Per Annum) (if any)
19. Last Employer/ Organisation
20. Address of Last Employer/
Organisation
21. Working Experience
No. Position Organisation Year
1.
2.
3.
4.
5.
ApplicantsSignature Date
Note: This form is to be submitted together with documents / information as per listed in Appendix A.
It is compulsory to be completed by applicant.
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NO. DOKUMEN PK.(O).KPK.PSA.02 (L10) Pin.1
TARIKH KUATKUASA 11 APRIL 2014
MUKA SURAT 4 daripada 5
FOR INDIVIDUAL APPLICANT / SPOUSE (THROUGH MM2H LICENSED COMPANY) v1.2
4
C. DECLARATION BY DIRECTOR OF MM2H LICENSED COMPANY
I , NRIC No , Designation
, from company
agree that:
1. All information given in the application form and the attached supporting documents are genuinely
correct and true; and
2. that any false information given by the applicant / MM2H Licensed Company will result in the Social
Visit Pass issued to the applicant/ dependents under this Programme cancelled without further notice
and action taken upon the Licensed Company as deemed necessary by the Ministry of Tourism and
Culture Malaysia.
Dated this (day) of (date) in the month of of the year
at
(address)
in the State of ;
Country ;
Date: Signature of the above named:
Signed and executed by the above named in my presence:
Signature of Witness :
Full name of Witness :Nationality :
Passport/ MyKad Number :
Date :
7/24/2019 Through Agent Application Form (Complete)
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NO. DOKUMEN PK.(O).KPK.PSA.02 (L10) Pin.1
TARIKH KUATKUASA 11 APRIL 2014
MUKA SURAT 5 daripada 5
FOR INDIVIDUAL APPLICANT / SPOUSE (THROUGH MM2H LICENSED COMPANY) v1.2
5
* For office use only:
Individual
With wife [Number of wives : person(s)]
With children [Number of children : person(s)]
Additional Information :
* IMPORTANT:
o Submission of application by third parties for the MM2H Programme is only authorised to MM2H Licensed
Agents. A list of registered MM2H licensed agents is available on the LICENSING page of the MM2H
Centre website at http://www.mm2h.gov.my.
7/24/2019 Through Agent Application Form (Complete)
10/19
NO. DOKUMEN PK.(O).KPK.PSA.02 (L11) Pin.1
TARIKH KUATKUASA 11 APRIL 2014
MUKA SURAT 1 daripada 2
FOR CHILDREN BELOW 21 YEARS v1.2
1
MINISTRY OF TOURISM AND CULTURE MALAYSIAMalaysia My Second Home CentreTelephone: +603 88917424 Fax: +603 88917414
APPLICATION FORM FOR THE MALAYSIA MY SECOND HOME PROGRAMME
A. PARTICULARS OF APPLICANT
1. Full Name (Capital Letters)
2. Please tick () Gender Male Female
3. Place of Birth (Country)
4. Date of Birth (dd/mm/yyyy) / /
5. Nationality
6. Passport Number
7. Date of Expiry (dd/mm/yyyy) / /
8. Please tick () Student Pass Yes No
9. Student Pass Number (if any)
10. School/ College/ University
(if any)
Passport-sized
Photograph of
Applicant (coloured)
(3.5 x 5.0 cm)
7/24/2019 Through Agent Application Form (Complete)
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NO. DOKUMEN PK.(O).KPK.PSA.02 (L11) Pin.1
TARIKH KUATKUASA 11 APRIL 2014
MUKA SURAT 2 daripada 2
FOR CHILDREN BELOW 21 YEARS v1.2
2
11. Field of Study (if any)
12. Mailing Address
CountryCode
Area Code Number
13. Telephone Number 1) - -
2) - -
Applicant Signature Date
Note: This form is to be submitted together with the main/ principal application.
7/24/2019 Through Agent Application Form (Complete)
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LAMPIRAN 9JABATAN IMIGRESEN MALAYSIA
BORANG PERMOHONAN PAS LAWATAN
VISIT PASS APPLICATION FORM
PERATURAN-PERATURAN IMIGRESEN, 1963 [Peraturan 11(12) dan 11(15)] IM. 12 - Pin. 1/97
*Jenis Pas
Iktisas
Sosial
Berniaga Kerja Sementara
Type of Pass
Professional
Social
Business Temporary Employment
*Jenis Permohonan Baru LanjutanGambar Pemohon
Type of Application New ExtensionPhotograph Of
A. MAKLUMAT PEMOHON
ApplicantPARTICULARS OF APPLICANT (3.5 cm x 5.0 cm)
1. Nama Penuh (Huruf Besar)
Full Name (Capital Letter)
2. *Jantina Lelaki Perempuan 3.Tempat/Negara Lahir
Gender Male Female Place/Country of Birth
4.**Tarikh Lahir 5.Warganegara
Date of Birth Nationality
hari bulan tahun
day
month
year
B. MAKLUMAT PASPORT PERJALANAN / DOKUMEN PERJALANAN
PARTICULARS OF PASSPORT / TRAVEL DOCUMENT
6.Jenis Dokumen Perjalanan 7. Nombor
Type of Travel Document Number
8.Tempat / Negara Dikeluarkan 9. **Sah SehinggaPlace / Country of Issue Valid Until
hari bulan tahun
day month year
C. MAKLUMAT PENGANJUR DI MALAYSI A
PARTICULARS OF SPONSOR IN MALAYSIA
10. Nama Penuh (Huruf Besar)
Full Name (Capital Letter)
11.No. Kad Pengenalan 12. No. Telefon
NRIC Telephone No.
13.Alamat
Address
NegeriState
D. KEPERLUAN VISA
VISA REQUIREMENT
14.*Adakah Visa Diperlukan Ya Tidaksa equ remen es
No
15.*Jenis Visa Sekali Perjalanan Berulangkali Perjalanan
Type of Visa Single Entry Multiple Entry
Tarikh Tandatangan Pemohon / Penganjur
Date Signature of Applicant / Sponsor
Borang ini hendaklah ditaip. Tandakan (x) dalam petak yang berkenaan. ** Format Tarikh 99/99/9999
This form should be typed. Mark (x) in the appropriate box
. Date Format DD/MM/YYYY
7/24/2019 Through Agent Application Form (Complete)
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NO. DOKUMEN PK.(O).KPK.PSA.02 (L13) Pin.1
TARIKH KUATKUASA 11 APRIL 2014
MUKA SURAT 1 daripada 3
BORANG RB I
RB I Form
1
MEDICAL REPORT
FOR MALAYSIA MY SECOND HOME PROGRAMME
PERINGATANReminder
BAHAGIAN II DAN II HENDAKLAH DIISI OLEH PEMOHON YANG BERKENAAN
Part I and II are to be completed by the applicant
1. BAHAGIAN I : BUTIR-BUTIR PERIBADI PEMOHON
Part I : Personal Particulars of Applicant
a) NAMA PENUH :
Full name: (DALAM HURUF BESAR/ IN CAPITAL LETTERS)
b) NAMA LAIN (JIKA ADA) :
Other Name (if any) (DALAM HURUF BESAR/ IN CAPITAL LETTERS)
c) JANTINA :
Gender:
d) NOMBOR PASPORT :
PassportNumber:
e) TARIKH DAN TEMPAT LAHIR :
Date and Place of Birth:
2. BAHAGIAN II : LATAR BELAKANG KESIHATAN
Part II: Medical History
a) ADAKAH ANDA PERNAH MENGHADAPI PENYAKIT BERIKUT?
Have you every suffered from the following ailments?
YA TIDAK JIKA YA, BERI ULASAN
Yes No if yes, give brief details
i. PENYAKIT OTAK
Mental Illness
ii. BATUK KERING
Tuberculosis
iii. SAWAN
Epilepsy
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7/24/2019 Through Agent Application Form (Complete)
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NO. DOKUMEN PK.(O).KPK.PSA.02 (L13) Pin.1
TARIKH KUATKUASA 11 APRIL 2014
MUKA SURAT 3 daripada 3
BORANG RB I
RB I Form
3
DECLARATION BY APPLICANT
I , Passport No. ,
issued by the Government of agree that:
1. All information given in the application form and the supporting documents are genuinely
correct and true; and
2. Any false information given by the applicant / Licensed Company will result in the Social
Visit Pass issued under this Programme being cancelled without further notice.
Date this day of (month) (year) at
(address)
in the State of ,
Country .
Date: Signature of the above named
7/24/2019 Through Agent Application Form (Complete)
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NO. DOKUMEN PK.(O).KPK.PSA.02 (L15) Pin.1
TARIKH KUATKUASA 11 APRIL 2014
MUKA SURAT 1
1
Director
Malaysia My Second Home Centre
Level 1, No 2, Tower 1,
Jalan P5/6, Precinct 5,
62200 Putrajaya,
MALAYSIA. Date:
AUTHORIZATION LETTER
I /we __________________________ Passport Number __________________ hereby attached the
financial statements for purpose of participation in Malaysia My Second Home Programme as follows:
1. Account No __________________________ from ______________________________
2. Account No __________________________ from ______________________________
3. Account No __________________________ from ______________________________
4. Account No __________________________ from ______________________________
5. Account No __________________________ from ______________________________
I /we hereby give permission/consent to the authorized officer(s) from Malaysia My Second Home Centre,
Ministry of Tourism and Culture Malaysia to verify my/our financial status or account with the said
financial institution (s).
The permission hereby given is solely for the purpose of my/ours participation in the Malaysia My Second
Home Programme.
Signature,
__________________
Name:
Address:
Telephone Number:
(the said financial institution and branch)
(the said financial institution and branch)
(the said financial institution and branch)
(the said financial institution and branch)
(the said financial institution and branch)
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Appendix 12
GOVERNMENT OF MALAYSIA
Immigration Ordinance, 1959
(F.M. 12 of 1969)
Immigration of Malaysia Regulation, 1963
(F.L.W. 228/63)
PERSONAL BOND
(Regulations 18)
Wheres it is a condition of the issue of aVisit Pass (Social Visit) to me /
of
that there furnished by me / on behalf of the said
will comply with the provisions of the Ordinance and of any
regulations made there under and with any conditions imposed in respect of, or instructions
endorsed on such pass.
Now I, NRIC . of
do hereby
bind myself that I / the said will comply
with the provisions of the above Act and of any regulations made there under and with any
special conditions imposed in respect of, or instructions endorsed on suchVisit Pass (Social
Visit) pass and in case of my / the said
making default therein, I hereby bind myself to forfeit to the Government of Malaysia the sum of
dated this day of at
in the state of .
Signature of the abovenamed
Signed and executed by the above named
In my presenceSignature of Witness :
Full name of Witness :
Address of Witness :
Stamp
RM10.00
By the stamping
office in Inland
Revenue Board
of Malaysia
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Security Bond/ Bank Guarantee Rates
RM 2000.00
Canada
USA
Colombia
Angola
Burkina FasoBurundi
Cameroon
Central African Republic
Republic Congo
Republic Democratic Congo
Cote D'Ivoire
Djibouti
Equatorial Guinea
Eritrea
EthiopiaGuinea-Bissau
Ghan
Liberia
Mali Mozambique
Niger
Nigeria
Rwanda
Western Sahara
RM1000.00
Japan
South Korea
Macao
Hong Kong
RM1000.00
Japan
South Korea
Macao
Hong Kong
RM1500.00
Saudi Arabia
Africa
Australia
British C.I
Brunei
China
Europe
Iran
Iraq
Portugal C.ITaiwan
Tunisia
Vietnam
RM 750.00
Bangladesh
Phillipines
India
Myanmar
Nepal
Pakistan
Sri Lanka
Fee for other
countries isRM1500.00
RM500.00
Indonesia
RM300.00
Thailand
RM200.00
Singapore
Source :http://www.imi.gov.my/index.php/en/main-services/visa/security-bond
Last Updated on Friday, 09 March 2012 02:10
http://www.imi.gov.my/index.php/en/main-services/visa/security-bondhttp://www.imi.gov.my/index.php/en/main-services/visa/security-bond7/24/2019 Through Agent Application Form (Complete)
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MALAYSIA MY SECOND HOME
BORANG KENYATAAN PENAJA (SPONSOR DECLARATION FORM)
(SILA SERTAKAN SA LINAN KAD PENGENALAN)
Nama Penaja (Sponsors Name) :
Alamat (Address) :
No. Telefon (Telephone No.) :
1. Apakah pekerjaan dan pendapatan anda (Occupation and salary)?
2. Bagaimanakah anda mengenali pemohon (How did you know the applicant)?
3. Pernahkah pemohon datang ke Malaysia (Has the applicant come to Malaysia before)?
4. Apakah pekerjaan pemohon sekarang (Applicants present Occupation)?
5. Di mana alamat pemohon sekarang (Applicants present address)?
6. Apakah tujuan pemohon memohon program ini (Reason for applicant applying for this
Programme)?
7. Kedudukan kewangan pemohon (nyatakan jumlahnya) :
(Details of applicants financial status give the amount) :
7.1 Bank tempatan (Local bank) :
7.2 Bank luar negeri (Foreign bank) :
7.3 Pencen (Pension) :
7.4 Saham (Shares) :
7.5 Lain-lain (Others) :
8. Adakah pemohon memiliki Insuran Kesihatan? Ya/Yes Tidak/No
(Is the applicant covered by Medical Insurance)
9. Adakah anda bertanggungjawab ke atas pemohon dengan menandatangani Personal Bond?
(Will you accept responsibility of the applicant by signing the Personal Bond)?
Ya/Yes Tidak/No
SEGALA KENYATAAN YANG SAYA BERIKAN ADALAH BENAR.
(ALL THE ABOVE STATEMENTS ARE TRUE)
(TANDATANGAN PENAJA / SIGNATURE OF SPONSOR)
TARIKH (DATE) :