(CPA 2B-2) Admission to Membership: Special MIA Pathway

1. PERSONAL DETAILS
Title:*
Tan Sri/Dato'/Datuk/Prof/Dr/Mr/Ms/Mrs/Mdm
Name:*
In block letters, as per Identity Card/ Passport
Identity Card No./ Passport No.:*
Passport No. for non-citizens only
Date of Birth:*

DayMonthYear
DD-MM-YYYY
Email address:*
e.g. abc@xxxx.com
Contact No:*
e.g. 012-xxxxxxx
Nationality*
Tax Identification Number (TIN):*
Check your TIN here: https://mytax.hasil.gov.my/ezHasil?data=e-Daftar&id=ezHasil%20sebelum
YesNo
Correspondence address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
From MIA (including their website, email blasts, events and posts on social media)From MICPA (including our website, email blasts, events and posts on social mediaFrom other MICPA membersFrom my employer / partner / co-workersOther
2. ACADEMIC AND PROFESSIONAL QUALIFICATIONS
Please provide a summary of your tertiary academic qualifications and details of your membership with other professional bodies, if applicable.

A template of the summary can be assessed from the link below

Download: Template: Academic and Professional Qualifications

You will also need to provide:
- a copy of your academic degree/diploma
- transcripts
- membership certificate from your professional body
- practicing certificate
- letter of good standing from your professional body
Please upload all documents in the corresponding spaces below. Note that all references and letters of good standing must be addressed to MICPA, signed and dated within 3 months of the date the application is submitted
Please upload your academic degree(s) and/or transcripts here:*

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Please upload your membership certificate(s), practising certificate and a letter of good standing from your professional bod(ies) here:*

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3. WORK EXPERIENCE(S) POST PROFESSIONAL QUALIFICATION
Please provide a list of your work experience, starting with the most recent, AFTER obtaining your professional membership/qualification. You may download a template from the link below

DOWNLOAD - Template: Work Experience

You will also need to provide a letter of support from your employer. Note that all references and letters of good standing must be addressed to MICPA, signed and dated within 3 months of the date the application is submitted
Please upload your letter of support and work experience summary in the space below using the template provided above*

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4. PRACTICE/FIRM DETAILS
Name of Employer/Practice:*
Type of business*
Audit, Tax, Advisory, etc
Position held*
Audit partner/Tax Director
Business Email:*
example@example.com
Business Contact Number:*
e.g. 03-1234567
Business Address:*

Street Address

Street Address Line 2

City/TownState

Postcode
Please upload a copy of Form 5 lodged with the Companies Commission of Malaysia*

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Details on current firm/practice

Please provide details on your current firm/practice using the template below. We require brief information on your firm/practice's main office/HQ as well as branches (if any). These include:
- Name of partner(s) and their respective professional qualification if any
- List of different entities under the firm/practice
- List of clientele, and their industries and those which are under your purview
- Totoal manpower in the main office/HQ, and branches and those who are under your line management
DOWNLOAD: Template: Information on Practice and Branches (MIA Pathways)
Please upload details of your firm/practice and branches (if any) using the template above in the space below*

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5. AUDIT, TAX AND/OR LIQUIDATOR LICENCES
AuditTax - issued under Section 153 of the Income Tax Act, 1967Liquidator - issued under Section 433 of the Companies Act, 2016
Audit License Approval Date

DayMonthYear
Please upload your audit license approval and renewal letter for the past 2 years

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Tax License Approval Date

DayMonthYear
issued under Section 153 of the Income Tax Act 1967
Please upload your tax agent license approval and renewal letter for the past 2 years (issued under Section 153 of the Income Tax Act 1967)

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Liquidator License Approval Date

DayMonthYear
issued under Section 433 of the Companies Act, 2016
Please upload your liquidator license approval and renewal letter (issued under Section 433 of the Companies Act, 2016)

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6. MIA AND AOB PRACTICE REVIEW
MIA Practice Review Date of Completion

DayMonthYear
DD/MM/YYYY
Type 1Type 2Type 3

AOB Practice Review Date of Completion (if any)

DayMonthYear
Date
AOB Practice Review - Type of Practice Passed (if any)
7. MICPA Practising Certificate
Members of the Institute who are engaged in public practice in Malaysia providing accounting, auditing, taxation or insolvency services are required to hold a practising certificate issued by the Institute.

Practising certificates shall normally be issued for a period not exceeding twelve months and ending on the thirty-first day of December and shall be renewed automatically for a period of twelve months on the first day of January next following when the appropriate renewal fee shall become due and payable.

You may submit your application for a MICPA Practising Certificate here
8. DECLARATION
I agree to have my financial statements being reviewed by MICPA if requiredI hereby declare that all particulars stated herein are correct and I have not been convicted of a felony or misdemeanoror been declared by any Court of competent jurisdiction to have committed any fraud, or been found guilty of any act ordefault discreditable to a public accountant or derogatory to the accountancy profession, or is adjudged bankrupt or hasfailed to satisfy a judgement debt or individually or as a partner has made an assignment for the benefit of creditors orunder any resolution of creditors or Order of the Court or any deed or document has had my estate placed in liquidationfor the benefit of creditors or has made any arrangement for the payment of a composition to creditors.I hereby undertake that, if admitted a member of the Institute, I shall be bound by the Constitution and the by-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 include:
1. personal data that the Institute believe to be relevant for the purpose of processing your application;
2. 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;
3. 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;
4. maintaining strict security systems designed to prevent unauthorised access to your personal data by a third party; and
5. ensuring all staff of MICPA with permitted access to your personal data are specifically required to observe these confidentiality obligations.
Should be Empty:

Rows	DATE
Remedial action plan submission
Follow up review
Final report
Cleared by MIA Practice Review Committee

(CPA 2B-2) Admission to Membership: Special MIA Pathway - In Practice

1. PERSONAL DETAILS

2. ACADEMIC AND PROFESSIONAL QUALIFICATIONS

Download: Template: Academic and Professional Qualifications

3. WORK EXPERIENCE(S) POST PROFESSIONAL QUALIFICATION

DOWNLOAD - Template: Work Experience

4. PRACTICE/FIRM DETAILS

Details on current firm/practice

5. AUDIT, TAX AND/OR LIQUIDATOR LICENCES

6. MIA AND AOB PRACTICE REVIEW

7. MICPA Practising Certificate

8. DECLARATION

Privacy Statement