Professional Documents
Culture Documents
Pursuant to the Medical Act 1971, you are required to register with the Malaysian
Medical Council (MMC) to practice medicine in Malaysia. Hence, your application
should be submitted PRIOR to practice;
2.
Pursuant to sections 12 and 13 of the Act, the Provisional Registration allows newly
qualified practitioners to undertake the general clinical training needed for full
registration under section 14 of the Act.
3.
4.
5.
5.2.
5.3.
5.4.
5.5.
5.6.
6.
Pursuant to section 19 of the Act, you are required to submit a copy of your recent
medical report and sick leaves if you:
6.1.
suffer from any medical illness or physical condition which may affect your
professional duties; and
6.2.
have any mental problem and/or have been admitted into a hospital for any
mental problem.
7.
8.
If your printed names in any of the submitted documents differ, you are required to
submit a Statutory Declaration;
9.
If the original documents are not in either Bahasa Malaysia or English, you need to
submit translated versions in either Bahasa Malaysia or English along with certified
copies of the document in its original language. Translated documents are only
acceptable if carried out by qualified translators or officers of appropriate embassy.
10.
11.
12.
You are advised to keep a copy of the documents submitted for your reference.
13.
14.
15.
16.
17.
Your certificate will be send by post. If you want to collect it personally, please state it
clearly in your application form. However, if you want someone to collect on your
behalf, he needs to produce a Letter of Authorization during collection.
18.
19.
FORM 4
(Regulation 20)
MEDICAL ACT 1971
(Section 12)
MEDICAL REGULATIONS 1974
APPLICATION FOR PROVISIONAL REGISTRATION
1.
2.
3.
Citizenship status*............
4.
5.
(a)
..
(b)
..
6.
7.
Particulars of Qualification*:
(a)
(b)
(c)
Date of qualification
8.
I attach:
(a)
(b)
Date*: //.
..
Signature of applicant*
DECLARATION
I, (full name)*...
the abovenamed 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
APPENDIX A FORM
Please affix your
recent passport size
photo here
(35mm x 45mm)
APPLICATION FOR
PROVISIONAL REGISTRATION
1.
2.
3.
CITIZENSHIP*:
4. RELIGION: ...
5.
6. ETHNIC: ....
7.
8.
..........
Postal: .....
.
COMMUNICATION*: Telephone - Office: - Fax: -.
9.
Mobile: -
Email: Official:..@.
Personal:....@.........
10.
11.
b. Collect In Person
c. Somebody on my Behalf
Date: ______/______/______
CHECKLIST:
1. The following documents need to be submitted by ALL applicants :
1.1.
1.2.
1.3.
1.4.
1.5.
1.6.
1.7.
1.8.
2.
2.2.
2.3.
A certified true copy of a Sijil Pelajaran Malaysia or offer letter from SPA,
whichever applicable.
3.
3.2.
3.3. A certified true copy of your marriage certificate for foreign spouse of
Malaysian, if applicable.
4.
5.
4.1.
4.2.
5.2.
1.
2.
b.
c.
d.
Notary Public;
e.
f.
Justice of Peace.
*For Malaysian graduates from foreign medical universities that wish to
apply for registration with the MMC, documentations should be certified
by Malaysian government officers stationed in the respective foreign
countries.
2.2.
2.3.
2.4.
3.
a.
b.
c.
d.
e.
f.
Signature of a Person
Name in Full
MMC Full Registration Number
Designation in Full
These details must be rubber-stamped.
A Complete Address
4.
If your printed names in any of the documents submitted differ, please submit a
Statutory Declaration.
5.
If the original documents are not in either Bahasa Malaysia or English, you need to
submit translated versions in either Bahasa Malaysia or English along with certified
copies of the document in its original language. Translated documents are only
acceptable if carried out by :
a. Malaysian certified court translators;
b. Official Malaysian government agencies;
c. Malaysian officers in the language faculty of public universities;
d. Malaysian officers of the appropriate embassies
6.
Any certification which does not conform to this Guideline will be considered invalid
and NOT accepted.
7.
Similarly, any document will be considered invalid and NOT accepted if:
8.
a.
b.
Revised:
First: 18 December 2008.
Second: 11 June 2009.
Third : 13 Okt 2011