MALAYSIA MY SECOND HOME (MM2H) CENTRE APPENDIX 2 Ministry of Tourism and Culture Malaysia

For direct application only Please tick ( ) MALAYSIA MY SECOND HOME (MM2H) CENTRE APPENDIX 2 Ministry of Tourism and Culture Malaysia 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) For official use Please tick ( ) 2. A copy of resume by the main applicant which includes the following information: o o o Academic qualification Working experience 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. Personal Bond 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. Updated as of May 2013 1

MALAYSIA MY SECOND HOME (MM2H) CENTRE APPENDIX 2 Ministry of Tourism and Culture Malaysia For direct application only Please tick ( ) 9. Form RB I (downloadable from MM2H website) For official use Please tick ( ) 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 o o Letter of Confirmation from Medical Specialist/ General Practitioner (if accompanied by children aged 21 years and above with disabilities). Statutory Declaration by main applicant to bear all expenses and financial requirements during stay in Malaysia for dependents. 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/etc) 14. Financial Authorization Letter; to verify the financial documents with the relevant financial Institutions (downloadable from MM2H website) Updated as of May 2013 2

MALAYSIA MY SECOND HOME (MM2H) CENTRE APPENDIX 2 Ministry of Tourism and Culture Malaysia IMPORTANT NOTES: o All copies must be certified TRUE COPIES OF ORIGINAL DOCUMENTS by EMBASSY/ HIGH COMMISSION/ SOLICITOR/ JUSTICE OF PEACE/ NOTARY PUBLIC/ COMMISSIONER OF OATHS/ 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 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 Personal 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 Personal Bond Form must be stamped (RM10.00) by the Stamping Office in Inland Revenue Board of Malaysia o The Personal Bond Form can be withdrawn when 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/ Personal Bond by Country. Updated as of May 2013 3

MALAYSIA MY SECOND HOME (MM2H) CENTRE Ministry of Tourism and Culture Malaysia APPENDIX 2(A) APPLICATION CHECKLIST FOR MALAYSIA MY SECOND HOME (MM2H) PROGRAMME - REQUIRED DOCUMENTS FROM APPOINTED MM2H LICENSED COMPANY For direct application only Please tick ( ) 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 For official use Please tick ( ) 2. Salinan lesen syarikat berlesen MM2H yang masih sah tempoh M2H 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 Kebudayaan Malaysia sekiranya tidak dapat mengemukakan lesen 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 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. Updated as of May 2013 4

FOR CHILDREN BELOW 21 YEARS v1.2 MINISTRY OF TOURISM AND CULTURE MALAYSIA Malaysia My Second Home Centre Telephone: +603 88917424 Fax: +603 88917415 APPLICATION FORM FOR THE MALAYSIA MY SECOND HOME PROGRAMME Passport- sized Photograph of Applicant (coloured) (3.5 x 5.0 cm) 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) Page 1 of 2

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. Page 2 of 2

FOR INDIVIDUAL APPLICANT / SPOUSE (THROUGH MM2H LICENSED COMPANY) v1.2 MINISTRY OF TOURISM AND CULTURE MALAYSIA Malaysia My Second Home Centre Telephone: +603 88917424 Fax: +603 88917415 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 Passport- sized Photograph of Applicant (coloured) (3.5 x 5.0 cm) 3 pieces 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- approved 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 7. Passport Number Updated June 2013 Page 1 of 5

FOR INDIVIDUAL APPLICANT / SPOUSE (THROUGH MM2H LICENSED COMPANY) v1.2 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. Updated June 2013 Page 2 of 5

FOR INDIVIDUAL APPLICANT / SPOUSE (THROUGH MM2H LICENSED COMPANY) v1.2 II) If retired (Q17 20): 17. Last employment 18. Pension Received (Per Annum) (if any) 19. Last Employer/ Organsation 20. Address of Last Employer/ Organisation 21. Working Experience No. Position Organisation Year 1. 2. 3. 4. 5. Applicant Signature Date Note: This form is to be submitted together with documents / information as per listed in Appendix A. Compulsory to be completed by applicant. Updated June 2013 Page 3 of 5

FOR INDIVIDUAL APPLICANT / SPOUSE (THROUGH MM2H LICENSED COMPANY) v1.2 C. DECLARATION BY DIRECTOR OF MM2H LICENSED COMPANY I, NRIC No, Designation agree that :, from company 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 in the State of ; Country ; (address) Date : Signature of the above named: Signed and executed by the above named in my presence : Signature of Witness : Fullname of Witness : Nationality : Passport/ MyKad Number : Date : Updated June 2013 Page 4 of 5

FOR INDIVIDUAL APPLICANT / SPOUSE (THROUGH MM2H LICENSED COMPANY) v1.2 * 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 Centre website at http://www.mm2h.gov.my. Updated June 2013 Page 5 of 5

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 Type of Pass Iktisas Professional Sosial Social Berniaga Business Kerja Sementara Temporary Employment *Jenis Permohonan Type of Application Baru New Lanjutan Extension A. MAKLUMAT PEMOHON PARTICULARS OF APPLICANT 1. Nama Penuh (Huruf Besar) Full Name (Capital Letter) Gambar Pemohon Photograph Of Applicant (3.5 cm 5.0 cm) 2. *Jantina Gender Lelaki Male Perempuan Female 3. Tempat/Negara Lahir Place/Country of Birth 4. **Tarikh Lahir Date of Birth hari bulan tahun day month year 5. Warganegara Nationality B. MAKLUMAT PASPORT PERJALANAN / DOKUMEN PERJALANAN PARTICULARS OF PASSPORT / TRAVEL DOCUMENT 6. Jenis Dokumen Perjalanan Type of Travel Document 7. Nombor Number 8. Tempat / Negara Dikeluarkan Place / Country of Issue C. MAKLUMAT PENGANJUR DI MALAYSIA PARTICULARS OF SPONSOR IN MALAYSIA 10. Nama Penuh (Huruf Besar) Full Name (Capital Letter) 11. No. Kad Pengenalan NRIC 9. **Sah Sehingga Valid Until 12. No. Telefon Telephone No. hari bulan tahun day month year 13. Alamat Address Negeri State D. KEPERLUAN VISA VISA REQUIREMENT 14. *Adakah Visa Diperlukan Visa Requirement Ya Yes Tidak No 15. *Jenis Visa Type of Visa Tarikh Date Sekali Perjalanan Single Entry Borang ini hendaklah ditaip. Tandakan (x) dalam petak yang berkenaan. This form should be typed. Mark (x) in the appropriate box. Berulangkali Perjalanan Multiple Entry Tandatangan Pemohon / Penganjur Signature of Applicant / Sponsor ** Format Tarikh 99/99/9999 Date Format DD/MM/YYYY

BORANG RB I RB I Form 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 : Fullname : (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? i. PENYAKIT OTAK Mental Illness YA TIDAK JIKA YA, BERI ULASAN Yes No If yes, give brief details ii. iii. BATUK KERING Tubercolosis SAWAN Epilepsy 1

BORANG RB I RB I Form 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. iii. iv. BAU Smell SENTUHAN Touch PENGLIHATAN Vision v. PENDENGARAN Hearing 2

BORANG RB I RB I Form 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 in the State of, Country. (address) Date : Signature of the abovenamed 3

Director Malaysia My Second Home Centre Ministry of Tourism and Culture Malaysia Level 1, No 2, Tower 1, Jalan P5/6, Precinct 5, 62200 Putrajaya, MALAYSIA. AUTHORIZATION LETTER Date: I /we Passport Number hereby attached the financial statements for the purpose of participation in Malaysia My Second Home Programme as follows: 1. Account No from (the said financial institution and branch) 2. Account No from (the said financial institution and branch) 3. Account No from (the said financial institution and branch) 4. Account No from (the said financial institution and branch) 5. Account No from (the said financial institution and branch) 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:

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) Stamp RM10.00 By the stamping office in Inland Revenue Board of Malaysia condition of the issue of a Visit 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 such Visit 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 abovenamed In my presence Signature of Witness : Fullname of Witness : Address of Witness :

MALAYSIA MY SECOND HOME BORANG KENYATAAN PENAJA (SPONSOR DECLARATION FORM) (SILA SERTAKAN SALINAN KAD PENGENALAN) Nama Penaja ( ) : 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 ( )? 5. Di mana alamat pemohon sekarang ( )? 6. Apakah tujuan pemohon memohon program ini (Reason for applicant applying for this Programme)? 7. Kedudukan kewangan pemohon (nyatakan jumlahnya) : ( 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) :

Security Bond/ Bank Guarantee Rates RM 2000.00 Canada USA Colombia Angola Burkina Faso Burundi Cameroon Central African Republic Republic Congo Republic Democratic Congo Cote D'Ivoire Djibouti Equatorial Guinea Eritrea Ethiopia Guinea- Bissau Ghan Liberia Mali Mozambique Niger Nigeria Rwanda Western Sahara RM1500.00 Saudi Arabia Africa Australia British C.I Brunei China Europe Iran Iraq Portugal C.I Taiwan Tunisia Vietnam RM500.00 Indonesia RM1000.00 Japan South Korea Macao Hong Kong RM 750.00 Bangladesh Phillipines India Myanmar Nepal Pakistan Sri Lanka RM300.00 Thailand RM1000.00 Japan South Korea Macao Hong Kong Fee for other countries is RM1500.00 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

BORANG RB II RB II Form 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 : Fullname : (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? i. PENYAKIT OTAK Mental Illness YA TIDAK JIKA YA, BERI ULASAN Yes No If yes, give brief details ii. iii. BATUK KERING Tubercolosis SAWAN Epilepsy 1

BORANG RB II RB II Form 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. iii. iv. BAU Smell SENTUHAN Touch PENGLIHATAN Vision v. PENDENGARAN Hearing 2

BORANG RB II RB II Form 3. BAHAGIAN III : PENGESAHAN DOKTOR Part III : Certification by Doctor TO BE COMPLETED BY A REGISTERED DOCTOR I have this day examined Passport No. and certify that: i. He/ She is not suffering from any disease and is healthy. ii. iii. iv. He/ She is not very healthy but is not suffering from any contagious or infectious disease. He / She is not healthy and is suffering from contagious or infectious disease which makes his/ her presence dangerous to the community. He / She is not healthy and unfit for long distance travel, and chances of recovery is very slim. Signature and Name of Doctor : Position Held : Official Seal : Dated this day of (month) (year). 3