FORM A3-1

APPLICATION FOR REGISTRATION AS AN Applicant’s

current
INSPECTOR OF WORKS passport size
Section 10E of the Registration of Engineers Act 1967 (Revised 2015) photo

(To be completed by the Applicant in BLOCK LETTERS)

SECTION A (to be filled in by All)

Name : …………………………………………………………………………………………………..

Gender: *Male Date of Birth : …………………………………….

*Female Place of Birth : …………………………………….

Nationality : ………………………………... Identification Card No : ……………………………

Address in Malaysia (if any) : …………………………………………………………………………...

Tel. No.: ………………….. Mobile Phone No.: ………………. Fax No: …………………..

Postal address (if different from above) : ……………………………………………………………...

E-mail Address : ………………………………………………………………………….......................

Qualifications : ………………………………………………………………………….......................

……………………………………………………………………………………………………………..

SECTION B (to be filled in by Non-Malaysian)

Passport No.: …………………………………. Place of Issue : ………………………………….

Date of Issue : …………………………………. Date of Expiry : ………………………………...

Country of Birth : …………………………… Nationality : …………………………………..

Address in Country of Origin : …………………………………………………………………………

For Non-Malaysian with Permanent Residency:

(i) I have been a Permanent Resident of Malaysia since : ……………………………………

(ii) Permanent Resident Identification Card No.: ……………………………………………..

* Tick ( √ ) where applicable

PENALTY
Section 24(a) of the Registration of Engineers Act 1967 (Revised 2015) : “Any person, sole proprietorship, partnership or body
corporate who procures or attempts to procure registration or a certificate of registration under this Act be knowingly making or
producing or causing to be made or produced any false or fraudulent declaration, certificate, application or representation whether
in writing or otherwise, shall be guilty of an offence and shall, on conviction, be liable to a fine not exceeding fifty thousand ringgit,
or to imprisonment for a term not exceeding three years, or to both”.
 APPENDIX - A

BRANCH OF ENGINEERING

Listed below are branches of engineering registered by the Board of Engineers Malaysia.

Please tick ( √ ) in the appropriate branch of engineering.

Example: If your academic qualification is in Civil Engineering, please tick Civil √

Civil Mechanical

Electrical Chemical

Others (please specify): ……………………………………………………………………..

FORM A3-1

DECLARATION TO BE SIGNED BY THE APPLICANT

a) I, the undersigned, apply for registration as an Inspector of Works and if I am registered, I agree
to abide by:

i. Registration of Engineers Act 1967 (Revised 2015) and The Registration of Engineers
Regulations 1990 (Revised 2015) ; and

ii. Notifications and Circulars issued by the Board of Engineers Malaysia.

b) I hereby authorize the Board of Engineers Malaysia to seek clarification on any information
submitted in any manner and by any means as it deems fit and proper.

Date: ………………………………. ……………………………….

(Signature of Applicant)

DOCUMENTS TO BE ATTACHED WITH THIS APPLICATION FORM:

(i) Applicant to submit certified copies (by a Professional Engineer or Professional Engineer with
Practising Certificate recognized by the Board of Engineers Malaysia) of the following:
a) Diploma scroll and full official transcripts related to engineering/engineering technology only.
b) Degree scroll and full official transcripts (if any)
c) Identification Card (for Malaysian)
d) Permanent Resident and/or Passport (for Non-Malaysian)

(ii) The application shall be accompanied with a non-refundable processing fee of RM50.00 in the
form of money order, postal order, bank draft, cheque or any other form as determined by the
Board, made payable to the Lembaga Jurutera Malaysia.
 For Office Use Only

Start Date : ……………………………………. Application Status : ……………………………..

Application Date : …………………………….. Current Status : ……………………………….

Rejection Date : ………………………………. Circulation Date : ………………………………

Received Date : ………………………………. Approval Date : ………………………………

Note Date : ……………………………………. List Status : …………………………………..

Suffix : …………………………………………………………………………………………………
 APPENDIX A

SUMMARY OF EMPLOYMENT (Page No. …….)

Please detail the main duties you have performed with emphasis on the most recent years proceeding your
application.

Name : ………………………………………………………………………………………………….

Identification Card No./Permanent Resident Card and/or Passport : …………………………………..

Date Name, position

(month & year) Company Position Summary of Experience and Reg. No.
Relating to Each under whom
Appointment served

** Where space provided is sufficient please attached annexed sheet.

 APPENDIX A

SUMMARY OF EMPLOYMENT (Page No. …….)

Please detail the main duties you have performed with emphasis on the most recent years proceeding your
application.

Name : ………………………………………………………………………………………………….

Identification Card No./Permanent Resident Card and/or Passport : …………………………………..

Date Name, position

(month & year) Company Position Summary of Experience and Reg. No.
Relating to Each under whom
Appointment served

I hereby declare that I have worked as an Inspector of Works since ………………………………………...

in the field of …………………………………...... I certify that the above information provided are to the

best of my knowledge, accurate and correct in all respects.

………………………………………...
(Signature of Applicant)

Date : …………………………………

NOTE : The Summary of Employment need to be endorsed by a Professional Engineer/Professional

Engineer with Practising Certificate of the Engineering Consultancy Practice or the Employer.
 DECLARATION BY PROFESSIONAL ENGINEER/
PROFESSIONAL ENGINEER WITH PRACTISING CERTIFICATE

I, ………………………………………….....….………………………. * Professional Engineer (PE)/

Professional Engineer with Practising Certificate (PEPC) Registration No. ………………….………….

confirm herein that * Mr/Ms ………………………………………………………………………………

Identification No. ……………………………………………… is working as an Inspector of Works in the

field of ……………………………………………………………. under my supervision.

I hereby confirm the following:

Current position: …………………………………………………………………………………….

Responsibility : …………………………………………………………………………………….

…………………………………………………………………………………….

…………………………………………………………………………………….

…………………………………………………………………………………….

…………………………………………………………………………………….

Tenure of Office : …………………………………………………………………………………….

I certify that the information provided is, to the best of my knowledge, accurate and correct in all respects.

Signature:

………………………………………………………..

* PE No. / PEPC No. : ………………………………

Date : ………………………………………..….…

* Delete whichever is not applicable.

 APPLICATION FOR REGISTRATION AS AN INSPECTOR OF WORKS
CHECKLIST
(To be submitted together with Form A3-1)

Tick ( √ ) if it is applicable and has been fulfilled. Cross ( X ) if it is not applicable.

Applicant For Office Use

1. Form A3-1 has been duly filled and signed.

2. A processing fee of RM50.00

Courier service charge of RM15.00 for

* Option 1 -
delivery of Certificate of Registration.

The yearly subscription fee of RM30.00 for

* Option 2 -
BEM publication ‘The Ingenieur’.

3. A registration fee of RM50.00 (upon instruction and

approval from BEM only)

4. Copy of Identification Card

(cross with remarks “FOR BEM USE ONLY”

5. Copy of Permanent Resident Card and/or

Passport (Non-Malaysia)
(cross with remarks “FOR BEM USE ONLY”

6. Copy of Diploma scroll and full officials transcript

(first year to final year)

7. Copy of Degree scroll and full officials transcript (if any)

8. The diploma is accredited by Engineering Technology

Accreditation Council (ETAC) or by a Professional body
who is a signatory of Dublin Accord (DA).

9. Item 3, 4, 5 and 6 are certified by a Professional Engineer

or Professional Engineer with Practising Certificate
recognised by BEM.

10. A copy of passport size photograph

(please write your name at the back of the photograph).

11. Appendix A - Summary of Employment (if any)

12. Declaration by Professional Engineer/Professional Engineer

with Practising Certificate (if any)
Remarks:

……………………………………………………………………………………………………………….

……………………………………………………………………………………………………………….

……………………………………………………………………………………………………………….

……………………………………………………………………………………………………………….

I confirm that I have completed the above and fulfil For Office Use Only
BEM requirements.
Signature of Officer-in-Charge
Board of Engineers Malaysia

……………………………………………………. ……………………………………..
(Signature of Applicant)
Date :