A.

PARTICULARS OF APPLICANT
1.
Full NameCapital Letter
2.
Gender

4.
Date of Birth

Photograph of Applicant

Latest 3months white

background photo
35mm*50mm
Photo size
21-24mm
Head Size
28-33mm
Head Length

3.
Place/Country of Birth
Day/Month/Year

6.
Occupation

5.
Nationality

7.
Marital Status

8.
Address

Single
Divorced

Married
Others

9.
Tel No ________________________

B. PARTICULARS OF PASSPORT/TRAVEL DOCUMENT

10.
Travel Document

11.
Passport Number

12.
Place/Country of Issue

13.
Expiry Date

C. PARTICULARS OF SPONSOR IN MALAYSIA

( ONLY FOR MEV APPLICATION)

14.
Full Name(Capital Letter)
15./
Identity Card/Passport No.

16.
Tel No ___________________________

17.
Address
D. DETAILS OF APPLICATION
18.
Estimated date of travel
to Malaysia

Day/Month

19.
Estimate Duration of Stay

/ Sightseeing/Leisure
20.
Purpose of Stay

Transit

Visiting Friends/Relatives
Employment

21.
Type of Visa

Business

Conference

Study

Official Visit

OthersSpecify_ _ _ _ _ _ _

Single Entry

Day

_ _ _ _ _ _ _ _ _ _ _

Multiple Entries

Yes
Yes
Yes
Yes
Yes

E. OTHERS INFORMATION
A. Have you ever been prohibited from entering Malaysia:
B.
Have you ever been prosecuted in Malaysia:
C. Have you ever committed an offence in Malaysia:
D. Any valid Malaysia visa/permit:
E. Whether there is any altered passport, or damage in any way:

No
No
No
No
No

F. DECLARATION BY APPLICANT(IMPORTANT)
6
I hereby acknowledged and confirmed that my passport validity is at least six months upon arriving Malaysia.

I have read and understood all the questions in this application form and declared all information given are
correct and true. I understand that the outcome of my application will be decided by Embassy/Consulate General of
Malaysia. Any false, misleading or incomplete statement may result in rejection to my application.
/
Date

Signature of Applicant/Sponsor

_________________

_________________