MINISTRY OF HEALTH, MALAYSIA

HUMAN RESOURCE DIVISION

LEVEL 9, BLOCK E7, PARCEL E
FEDERAL GOVERNMENT ADMINISTRATION
CENTRE
62590 PUTRAJAYA

Tel. No. : 03-88832818

http://www.moh.gov.my

APPLICATION FORM FOR THE POST OF HOUSEMANSHIP IN THE

MINISTRY OF HEALTH, MALAYSIA
PERSONAL PARTICULARS
Name of post applied:

Recent
Photograph to be
affixed here

Full name of applicant:

(CAPITAL LETTER)
Date and place of birth:
Sex: Male / Female

Marital Status:
Passport No/
IC.No:

Nationality:
Permanent Address:

Mailing Address

E Mail Address

Contact Number

Languages Spoken:
Languages Written:
Name of spouse:
Designation / Work Place:

Nationality :

QUALIFICATION
Name of Medical Degree:
Bona fide student of:
University and year awarded:

PERSONAL REFERENCE
Name Two Referees as to your character and ability
1.

2.

Name

Address

Position

Name

Address

Position

Please attach testimonials from referees named above

Signature of applicant: ..
Date: ...

ANY ADDITIONAL INFORMATION

ADDITIONAL REQUIREMENTS:
(a)

Applicants must be free of any record of disciplinary action by the MMC

and current/previous employer, no record of crime or drug abuse and
possess satisfactory performance reports from the current/previous
employer;

(b)

Upon appointment, successful applicants are subjected to rules and

regulations applicable to the Malaysian civil service;

(c)

Applicants must be able to command & communicate in English; and

(d)

Applicants must be certified to be of good health and free from

transmissible diseases such as AIDS, STD, Hepatitis B, Hepatitis C, etc.
Medical report must be submitted along with the application form.

DECLARATION
I (full name).....
The above named applicant, hereby declare that the particulars stated in this
application are true and correct and the documents attached are true copies of
original documents which relate to me.
I have not any time been found guilty of an offence involving fraud, dishonesty or
moral turpitude or any offence punishable with imprisonment (whether in itself
only or in addition to or in lieu of a fine) for a term of two years or upward
Date :

..
Signature of Applicant

APPENDIX A
1.

Application form*
(4 copies)

2.

Curriculum vitae of applicant*

(4 copies)

3.

Certified true copy of Basic Medical Degree*

(4 copies)

4.

Certified true copy of bona fide student certificate from the

respective Medical Degree
(4 copies)

5.

Certified true copy of birth certificate and Identity Card or

passport and Marriage Certificate(for spouse of Malaysian)
(4 copies)

6.

Certified true copy of medical report (3 copies)

*Application without any one of these documents will not be entertained

CURRICULUM VITAE
OF APPLICANT (FOREIGN CITIZEN) FOR REGISTRATION
UNDER MEDICAL ACT 1971
1.

Full name of Applicant

2.

Nationality / Citizenship :

3.

Passport No.

4.

Date of Birth

5.

Gender

6.

Marital Status

: ....

7.

If married,
7.1

Name of spouse

: ..

Occupation of spouse : .
7.3

Nationality of spouse

7.4

Name of children / Age

: ..
:
:
:

8.

Residential address

9.

Address for postal communication (if different) :

10.

Particulars of Basic Medical Qualification

10.1

Bona fide Student of: .

10.2

Description of Qualification (in full): .

10.3

Institution which granted qualification: ..

10.4 Date of qualification:

11.

Reference (Name two referees as to your character and ability)

11.1

11.2

Name

Address

Position

Name

Address

Position

Signature of applicant: _____________________________________

Date: _____________________________________

MALAYSIAN MEDICAL COUNCIL

GUIDELINES & APPLICATION FORM FOR
PROVISIONAL REGISTRATION
Please take note:
a. The following information is provided to assist you.
b. Please read the information carefully before completing the application form.
c. You are expected to observe and comply with ALL the terms and conditions
stipulated herein.
d. Not adhering to any of the requirements may result in undue and unnecessary
delay in processing your application.
e. The Malaysian Medical Council will NOT be held responsible for any delay
due to your non-compliance with the terms and conditions set herewith.

1.

Pursuant to the Medical Act 1971, you are required to register with the Malaysian Medical
Council (MMC) to practice medicine in Malaysia;

2.

Pursuant to sections 12 and 13 of the Medical Act 1971, the Provisional Registration allows
newly qualified practitioners to undertake the general clinical training needed for full registration
under section 14 of the Act.

3.

You are entitled for the provisional registration if you:

a.

Possess a degree recognized by the MMC as listed in the Second Schedule) or pass the
Medical Qualifying Examination under section 12(1)(aa) of the Medical Act 1971; and

b.

Are appointed/employed by the public authorities.

4.

A provisionally registered medical practitioner is entitled to practice as a house officer in any of

the hospitals approved by the Medical Qualifying Board.

5.

To apply for the Provisional Registration,

Registration, the following documents with the number of copies
stated in brackets should be submitted::
5.1.

An application form for Provisional Registration FORM 4;

The application form should be completed in Block Capital as printed in the NRIC or
Passport preferably type-written. Please fill all mandatory fields marked * completely
and legibly.
*For resident and postal addresses in Form 4, please provide addresses in Malaysia.

5.2.

A standard passport size photo measuring 35cm by 45 cm affixed to the appropriate box
in the application form.

5.3.

A copy of the identity card;

5.4.

A copy of the birth certificate;

5.5.

A copy of the Sijil Pelajaran Malaysia or Malaysian Certificate of Examination, where

applicable.

5.6.

An original Deans Letter and certified true copy of a recognized basic medical degree.
(For Indonesian graduates Certified true copies of both the Sarjana Kedokteran and
Ijazah Kedokteran degrees.)

5.7.

A copy of both the Compulsory Rotating Houseman/Internship Certificate and Bona fide
Student Certificate (for Indian graduates only).

5.8.

A copy of your result transcripts covering the WHOLE course/study duration.

5.9.

A twenty ringgit processing fee (pursuant to Regulation 25 of the Medical Regulations

1974) in bank draft, money order, postal order or cheque in favor of The Registrar of
Medical Practitioners.
Practitioners. Please write your name and identity card number behind the
payment slip; and

5.10.

Pursuant to section 19 of the Medical Act 1971, a copy of your recent medical report if
you:

suffer from any illness or physical condition which may affect your professional
duties; and

have any mental problem and/or have been admitted into a hospital for any
mental problem.

6.

ALL documents should be certified according to the Guideline for Document Verification;

7.

Application should be submitted PRIOR to practice.

8.

Please allow 4 (FOUR) weeks for us to process your application once accepted.

9.

Application can be submitted in person or via post.

10.

You are advised to keep a copy of the documents submitted for your reference.
reference

11.

Please submit this application to:

The Registrar of Medical Practitioners,
Malaysian Medical Council,
Level 2, Block E1, Block E,
Federal Government Administrative Centre,
Federal Territory,
62518 PUTRAJAYA.

12.

Before submitting, please refer to the CHECKLIST provided.

13.

Upon receipt, you will be promptly notified.

14.

You are strongly advised to respond immediately to our notification for any shortcomings.

15.

Your certificate will be send by post. You may collect it personally from our office. However, if
you want someone to collect it on your behalf, please state it clearly in your application form with
a letter authorizing such person.

16.

Please feel free to contact us if you:

a.

were not acknowledged after submitting your application;

b.

do not hear from us after the processing period is over; and/or

c.

require any assistance or have any questions.

Your cooperation is greatly appreciated. Thank you.

Yours sincerely,

Dr. Hj. Wan Mazlan bin Hj. Mohamed Woojdy,

Secretary.
Updated: 12 December 2008.

FORM 4
(Regulation 20)
MEDICAL ACT 1971
(Section 12)
MEDICAL REGULATIONS 1974
APPLICATION FOR PROVISIONAL REGISTRATION

1.

Full name of applicant*:

2.

Identity Card No. * --...

3.

Citizenship status*............

4.

Date of Birth*: //.......

5.

(a)

Residential address*: ...

..
(b)

Address for postal communication (if different).

..
6.

7.

Particulars of Qualification*:
(a)

Description of Qualification (in full)...

(b)

Institution which granted qualification

(c)

Date of qualification

I attach the following documents in proof of my qualification and in support of this application *:
(a)
Citizenship Certificate (if any) No..
(b)

The following original diplomas, certificates etc:

8.

I attach:
(a)

document in proof of having been *selected for (subject to my being provisionally

registered/exempted from) employment in a resident medical capacity under section 13 (2)
of the Medical Act; and

(b)

document of proof of having been selected for service in a medical capacity under section
13 (3) of the Medical Act, subject to my being provisionally registered and having satisfied
the provisions of section 13 (2) of the Medical Act.

Date*: //.

* Delete whichever is inapplicable.

..
Signature of applicant*

DECLARATION
I, (full name)*... the above
named applicant, hereby declare that the particulars stated in this application are true and correct and the
documents attached are original documents which relate to me.
I further declare that immediately upon being provisionally registered, I shall engage in employment in a
resident medical capacity in accordance with the provisions of section 13 (2) of the Medical Act *and,
immediately upon completion of such employment, in service in a medical capacity in the public service
under section 13(3) of the Medical Act
I have not at any time been found guilty of an offence involving fraud, dishonesty or moral turpitude or an
offence punishable with imprisonment (whether in itself only or in addition to or in lieu of a fine) for a term
of two years or upward.
Date*//.

..........................
Signature of applicant*

CERTIFICATION OF IDENTITY
I, (full name)*... of (full
address)* .. being (professional
status)*.. do hereby certify that (name of
applicant)* whose application for registration as a
medical practitioner is submitted above is known to me personally and is in fact the person whose name
appears on this application.

Date* //

..
(Signature)*
Fully Registered Medical Practitioner or
Advocate and Solicitor or
an Officer in the Managerial and
Professional Group of the Public Service

ADDITIONAL INFORMATION

APPLICATION FOR
PROVISIONAL REGISTRATION

1.

Please affix your

recent passport size
photo here
(35mm x 45mm)

NAME*: Dr. ...

(In Block Capital as Printed in the NRIC or Passport)

2.

OTHER NAME: ....

(If any, including maiden name)

3.

CITIZENSHIP*:

4. RELIGION: ...

5.

GENDER*: Male/Female (Please select one)

6. ETHNIC: ....

7.

MARITAL STATUS: Single/Married/Divorced (Please select one)

If married: Name of Spouse: .......
Occupation: . Citizenship: .....

8.

ADDRESS: Residence: .....

..........
Postal: .....
.

9.

COMMUNICATION*: Telephone - Office: - Fax: -.

Mobile: -
Email: Official:..@.
Personal:....@..
.......

10.

BASIC MEDICAL DEGREE:

Name of the Awarding University: ....
Name of the Degree: .....
Date Awarded: ......
Signature of applicant:
applicant _____________

(NOTE:
NOTE: Use separate sheet if space is insufficient.)

Date: ______/______/______

CHECKLIST:
1.

The following documents need to be submitted by ALL applicants :

1.1.

A completed Provisional Registration application form (Form 4)

1.2.

An original Deans Letter and certified true copy of basic medical

degree.

1.3.

A result transcripts covering the WHOLE course/study duration.

1.4.

A recent passport-sized photograph.

1.5.

A RM20 registration fees in bank draft/money order/postal order in favor

of The Registrar of Medical Practitioners.

2.

The following additional documents need to be submitted by Malaysian

applicants only:
2.1.

A certified true copy of an identity card.

2.2.

A certified true copy of a birth certificate.

2.3.

A certified true copy of a Sijil Pelajaran Malaysia or offer letter from

SPA, whichever applicable.

3.

The following additional documents need to be submitted by Non-Citizens

only :
3.1.

A certified true copy of your passport.

3.2.

A certified true copy of an offer letter from SPA.

3.3. A certified true copy of your marriage certificate for foreign spouse of
Malaysian, if applicable.
4.

The following additional documents need to be submitted by Indian

University Graduates only:

5.

4.1.

A certified true copy of a Student Bona fide Certificate.

4.2.

A certified true copy of Rotating Internship Certificate.

The following additional documents need to be submitted by Indonesian

University Graduates only:
5.1.

A certified true copy of Sijil Kedokteran (S.KED).

5.2.

A certified true copy of Ijazah Kedokteran (Ijazah Profesi Dokter).

MALAYSIAN MEDICAL COUNCIL

GUIDELINES FOR DOCUMENT VERIFICATION
Please take note:
a. The following information is provided to assist you.
b. Please read the information carefully before completing the application form.
c. You are expected to observe and comply with ALL the terms and conditions
stipulated herein.
d. Not adhering to any of the requirements may result in undue and unnecessary
delay in processing your application.
e. The Malaysian Medical Council will NOT be held responsible for any delay
due to your non-compliance with the terms and conditions set herewith.
1.

A certified photocopy is considered valid and acceptable by the Malaysian

Medical Council only if it bears the following criteria:
1.1.

The document/s should be signed by designated or authorized signatories as

follows:
1.1.1

Any public officials holding administrative and professional posts;

1.1.2

Advocates and solicitors;

1.1.3

Commissioner for Oaths;

1.1.4

Notary public;

1.1.5 Malaysian Embassy or Consulate officials holding administrative

and professional posts; and
1.1.6
1.2.

1.3.

Justice of Peace.

Every certified documents shall bear all the following details:

a.

The name of the person certifying in full;

b.

In case of a medical practitioner registered with the Malaysian Medical

Council (MMC), please include the MMC Full Registration number;

c.

The designation of the person certifying in full;

d.

The complete address of the person certifying;

e.

The details must be rubber-stamped; and

f.

A signature and not an initial.

Documents certified by a Commissioner for Oaths must bear a seal

prescribed under Rule 19 of the Commissioner for Oaths Rules, 1993
enacted under the Courts of Judicature Act, 1964.

2.

Any certification which does not conform to para 1.1. and 1.2. will be considered
invalid and NOT accepted.

3.

Similarly, any document will be considered invalid and NOT accepted if:

4.

a.

It is certified by an individual on behalf of another person without his own

details printed;

b.

The signatures of the same individual are not similar or different.

An example of a proper and valid certification is as follows:

Certified True Copy,

Dr. Ahmad bin Muhammad,

MMC Full Registration No. 27666
Family Health Physician,
Klinik Kesihatan Putrajaya,
62250 PUTRAJAYA
W.P. PUTRAJAYA.

Signature of a Person
Name in Full
MMC Full Registration Number
Designation in Full
These details must be rubber-stamped.
A Complete Address

5.

For further details or enquiries, please contact us.

Your cooperation is greatly appreciated. Thank you.

Yours sincerely,

Dr. Hj. Wan Mazlan bin Hj. Mohamed Woojdy,

Secretary.
Dated: 14 September 2008.