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NO. DOKUMEN PK.(O).KPK.MM2H.02 (L1) Pin.1

TARIKH KUATKUASA 11 APRIL 2014

MUKA SURAT 1 daripada 2

MALAYSIA MY SECOND HOME (MM2H) CENTRE Ministry of Tourism and Culture Malaysia

1

MALAYSIA MY SECOND HOME (MM2H) PROGRAMME

CHECKLIST FOR DIRECT APPLICATION

1. Letter of Application (cover letter);

o Include information on personal background, intention to join the MM2H Programme, if

joining as a single or with family and briefly explain how you will support your 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 Form – Social 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. Letter of Good Conduct from your relevant government agency

8. Self-declaration on main applicant’s/ dependents health conditions – Form RB I

(downloadable from MM2H website)

9. Certified copy of Marriage Certificate (if accompanied by spouse)

For direct application only

Please tick ()

For official use

Please tick ()




MALAYSIA MY SECOND HOME (MM2H) CENTRE Ministry of Tourism and Culture Malaysia

2

10. 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)

11. Certified copies of latest 3 months bank statement/ other related financial document(s) to

indicate the financial capability to support stay in Malaysia;

12. Certified copies of latest 3 months payslip/ income statement (if employed/pension slip/etc)

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/ etc) or

government pensions into the applicant’s bank accounts

13. Financial Authorization Letter; to verify the financial documents with the relevant financial

institutions (downloadable from MM2H website)

IMPORTANT NOTES:

o All copies must be certified TRUE COPIES OF ORIGINAL DOCUMENTS by EMBASSY/ HIGH COMMISSION/

NOTARY PUBLIC/ 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 applicant’s 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 Security bond is to be submitted for main applicant only

o However, for dependents added after application has been approved, Personal Bond has to be submitted for each dependent.

o The Security Bond Form must be stamped (RM10.00) by the Stamping Office in Inland Revenue Board of Malaysia o The Security Bond is payable in the form of Cash or Bank Draft to the KETUA PENGARAH IMIGRESEN MALAYSIA o The Security Bond Fee can be withdrawn if the participant/ dependent decides to exit from the MM2H Programme o The amount chargeable is according to Country of Origin of the applicant/ participant. Please refer to Rate of Security

Bond by Country.

For direct application only

Please tick ()

For official use

Please tick ()

LAMPIRAN 9

JABATAN 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 Lanjutan Gambar Pemohon

Type of Application New Extension

Photograph Of

A. MAKLUMAT PEMOHON Applicant

PARTICULARS 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 Sehingga

Place / 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

Negeri State

D. KEPERLUAN VISA

VISA REQUIREMENT 14. *Adakah Visa Diperlukan Ya

Tidak

Visa Requirement Yes

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

NO. DOKUMEN PK.(O).KPK.MM2H.02 (L10)

Pin.1



FOR INDIVIDUAL DIRECT APPLICANT / SPOUSE v1.2

MINISTRY OF TOURISM AND CULTURE MALAYSIA Malaysia My Second Home Centre Telephone: +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


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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 (Q13 – Q16):

13. Current Employment

14. Income (Per Annum)

15. Current Employer/

Organisation

16. Employer’s Address


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II) If retired (Q17 – 20):

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.

Applicant’s Signature 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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C. DECLARATION BY INDIVIDUAL DIRECT APPLICATION

I , Passport No , Issued by

Government of agree that:

1. All information given in the application form and the attached supporting documents are genuinely

correct and true; and

2. that I hereby authorize the Malaysia My Second Home (MM2H) Centre, under the Ministry of Tourism

and Culture Malaysia to verify my financial records with the financial institutions as listed in items (12)

and (13) of Appendix A; and

3. that any false information given by me as the main applicant will result in the Social Visit Pass issued

to me and my dependents (if applicable) under this Programme cancelled without further notice

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 :


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* 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.


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FOR CHILDREN BELOW 21 YEARS v1.2

MINISTRY OF TOURISM AND CULTURE MALAYSIA Malaysia My Second Home Centre Telephone: +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)


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FOR CHILDREN BELOW 21 YEARS v1.2

11. Field of Study (if any)

12. Mailing Address

Country Code

Area Code Number

13. Telephone Number 1) - -

2) - -

Applicant Signature Date

Note: This form is to be submitted together with the main/ principal application.




BORANG RB I RB I Form

1

MEDICAL REPORT

FOR MALAYSIA MY SECOND HOME PROGRAMME

PERINGATAN

Reminder

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 :

Sex:

d) NOMBOR PASPORT :

Passport Number :

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





2

YA TIDAK JIKA YA, BERI ULASAN

Yes No if yes, give brief details

iv. LELAH

Chronic Asthma

v. HEPATITIS A / B

vi. AIDS

vii. KENCING MANIS

Diabetes Mellitus

viii. PENYAKIT JANTUNG

Heart Disease

b) RANGSANGAN BERFUNGSI TIDAK BERFUNGSI

Senses Functioning Not Functioning

i. RASA

Taste

ii. BAU

Smell

iii. SENTUHAN

Touch

iv. PENGLIHATAN

Vision

v. PENDENGARAN

Hearing





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




Director

Malaysia My Second Home Centre

Level 1, No 2, Tower 1,

Jalan P5/6, Precinct 5,

62200 Putrajaya,

MALAYSIA. Date:

FINANCIAL STATUS OR ACCOUNT VERIFICATION 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 authorised 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)








Director

Malaysia My Second Home Centre

Level 1, No 2, Tower 1,

Jalan P5/6, Precinct 5,

62200 Putrajaya,

MALAYSIA. Date:

JOB AND SALARY VERIFICATION AUTHORIZATION LETTER

I/We __________________________ Passport Number __________________ hereby give

permission/consent to the authorized officer(s) from Malaysia My Second Home Centre

(MM2H), Ministry of Tourism and Culture Malaysia to verify my/our job and salary status with

the organization that I have declared to MM2H Centre.

The permission hereby given is solely for the purpose of my/ours participation in the Malaysia

My Second Home Programme.*

I/We declare that all information provided is to be true in every particular. Should I/we give

false, inaccurate and wrong information, I am/we are subject to any legal action determined by

the MM2H and I/we understand that my/our application will not be considered and will be

rejected.

Signature,

_______________________

Name:

Address:

Telephone Number:

*Information will be kept private and confidential by MM2H Centre.

Appendix 12

GOVERNMENT OF MALAYSIA

Immigration Ordinance, 1959

(F.P.M. 12 of 1969)

Immigration of Malaysia Regulation, 1963

(F.L.W. 228/63)

SECURITY BOND

(Regulations 18)

Where’s it is a condition of the issue of a to me / the said

of

that there furnished by me / on behalf of the

said security in the sum of as

a guarantee that I / the said will comply with the provisions of the above 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 such 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 which I hereby deposited with the Government of Malaysia vide

Receipt No. .

Dated this day of at in

the state of .

Signature of the abovenamed

Signed and executed by the abovenamed

In my presence

Signature of Witness :

Fullname of Witness :

Address of Witness :

FILE REF :

Note : The amount chargeable is according to country of origin of the participant : refer to Rate of Security Bond by country

Stamp

RM10.00

By the stamping

office in Inland

Revenue Board

of Malaysia

Security Bond/ Bank Guarantee Rates

RM 2000.00 RM1000.00 RM1000.00

Canada Japan Japan

USA South Korea South Korea

Colombia Macao Macao

Angola Hong Kong Hong Kong

Burkina Faso

Burundi

Cameroon

Central African Republic

Republic Congo

Republic Democratic Congo

Cote D'Ivoire

Djibouti

Equatorial Guinea

Eritrea

Ethiopia

Guinea-Bissau

Ghana

Liberia

Mali Mozambique

Niger

Nigeria

Rwanda

Western Sahara

RM1500.00 RM 750.00 Fee for other

countries is

Saudi Arabia Bangladesh RM1500.00

Africa Phillipines

Australia India

British C.I Myanmar

Brunei Nepal

China Pakistan

Europe Sri Lanka

Iran

Iraq

Portugal C.I

Taiwan

Tunisia

Vietnam

RM500.00 RM300.00 RM200.00

Indonesia Thailand Singapore

Source : http://www.imi.gov.my/index.php/en/main-services/visa/security-bond

Last Updated on Friday, 09 March 2012 02:10

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