(CPA 12) Application for MICPA Practising Certificate

(CPA 12) Application for MICPA Practising Certificate

For the purpose of application for MICPA Practising Certificate under by-law 56(1)
1. Personal Details
Name:*
In block letters, as per Identity Card/ Passport
MICPA Member No:
Date of Admission to MICPA Membership:

DayMonthYear
DD-MM-YYYY
Mobile number:*
e.g. 012-xxxxxxx
Personal email address:*
e.g. abc@xxxx.com
Tax Identification Number (TIN) No:*
Check your TIN here: https://mytax.hasil.gov.my/ezHasil?data=e-Daftar&id=ezHasil%20sebelum
Do you need an e-invoice?:*

YesNo
If you are a member of other professional bodies, please state here:
If you currently hold a Practising Certificate from MIA please state the issuance date

DayMonthYear
DD/MM/YYYY
2. DETAILS OF AUDIT FIRM/PRACTICE

Practice where the MICPA Practicing Certificate will be used
Name of Firm/Practice:*
Address of Firm/Practice*

Street Address

Street Address Line 2

City/TownState

Postcode
Date Commence Practice*

DayMonthYear
Note: Applicant is required to submit a copy of the Form 5 lodged with the Companies Commission of Malaysia, if applicable
File Upload

Cancelof
Are any of your current partner(s) member(s) of MICPA?*

YesNoNot applicable

Please indicate your MOST RECENT 24 months professional experience DURING/POST MICPA membership:

3. DECLARATION BY APPLICANT
Please tick the boxes below to confirm your declaration*

I hereby declare that all the information contained herein is true and correct.I hereby undertake that, if admitted a member of the Institute, I shall be bound by the Articles of Association and the bye-laws of the Institute and the regulations made thereunder that are now in force or may hereafter from time to time be made.
Privacy Statement

The Institute shall preserve the confidentiality of all your personal data obtained or processed which includes but not limited to:
- personal data that the Institute believe to be relevant for the purpose of processing your application;
- disclosing your personal data to any external organisation unless we have your consent or are required by law, governmental, regulators under proper authority for the purpose of verifying your qualifications and professional membership;
- keeping your personal data on our records accurate and up-to-date – for this purpose, you are required to update the Institute of your personal data in writing or update your personal data on Member’s Portal should there be any changes;
- maintaining strict security systems designed to prevent unauthorised access to your personal data by a third party; and
- ensuring all staff of MICPA with permitted access to your personal data are specifically required to observe these confidentiality obligations.
Should be Empty:

1. Personal Details