AMMI Membership Application Form

AMMI Membership Application Form
(A) Company Information
Company Name*
Company Registration No*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone*

Area CodePhone Number
Website*
Ownership*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
ManufacturerContract ManufacturerImporter/Commercial OfficeServicesOthers
If others, please state
Latex and Dipping technologyMedical Electronics TechnologyMetal TechnologyPackaging TechnologyPlastic TechnologySterilisation TechnologyServicesOthers
If others, please state
Total Revenue (RM)*
Percentage (%) of Medical Device Revenue compared to Total Revenue*
(percentage/ %v)
Local Medical Device Revenue (RM)*
Export Medical Device Revenue (RM)*
Total Number of Employees in Malaysia*
Total amount of HRDF Levy contribution per year
Number of Employees accounted for HRDF Levy
(B) Representative Information

Representative chosen should hold the designation of Director/ General Manager or equivalent only.
Name (Member Rep) *
Designation *
Director/ General Manager or equivalent
E-mail*
Mobile Phone Number*

Area CodePhone Number
(C) RA/QA and HR Representatives

Kindly nominate a RA, QA and HR professional from your company. He/she will be invited to relevant meetings and kept in the mailing loop related to Regulatory Affairs or HR issues respectively.
1. Name (RA Rep)
Designation
E-mail
Mobile Phone Number

Area CodePhone Number
2. Name (QA Rep)
Designation
E-mail
Mobile Phone Number

Area CodePhone Number
3. Name (HR Rep)
Designation
E-mail
Mobile Phone Number

Area CodePhone Number
(D) Products Manufactured
ODMOEMParts for Medical DevicesNot applicable
What is the % of activity driven by Medical Device Manufacturing
Types of Products Manufactured
Commencement
(E) Services Offered
Services
Commencement
(F) ISO/ Standards Achieved
ISO Standards Achieved in Malaysia
Other Standards Achieved
Upload the Company Logo

Upload a File
Logo should be in jpg, tif or png format. Cancelof
Upload the Corporate Profile

Upload a File
Corporate Profile in PPT or PDF format Cancelof
Upload the latest audited account

Upload a File
PDF format Cancelof
Upload ISO certificate

Upload a File
ISO 13485 and/or ISO 9001 Cancelof
Upload MITI Manufacturing License

Upload a File
MITI Manufacturing License / MIDA Letter Cancelof
Upload Medical Device Authority (MDA) License

Upload a File
MDA License Cancelof
Additional Remarks
All members shall provide AMMI's Secretariat Office complete information and data as required in the yearly questionnaire. This is essential to produce a comprehensive and updated annual Industry Survey of the Association. Information provided by members wil be kept confidential by the Secretariat Office.
Should be Empty:

AMMI Membership Application Form

(A) Company Information

(B) Representative Information

(C) RA/QA and HR Representatives

(D) Products Manufactured

(E) Services Offered

(F) ISO/ Standards Achieved