FOR OFFICE USE Ref. No.

: Response By:

BRAIN GAIN MALAYSIA PROGRAMME RSET REGISTRATION FORM

Thank you for your interest in the Brain Gain Malaysia (BGM) Programme. We are looking for researchers, scientists, engineers and technologists (RSET) to collaborate with institutions of higher learning, research institutes, and industries in Malaysia. Please fill in your details to assist us to match your expertise with institutions in Malaysia through collaborations and short-stint visits. The BGM Programme offers incentives to RSETs approved under the programme. PERSONAL INFORMATION Title: Mr Miss ______________________ Name: Sex: Email: Male Female Country of birth: Nationality: EXPERTISE Qualifications (Academic & Professional): Field of expertise: Professional experience: 1 5 years 6 - 10 years Your intended participation in BGM Programme as: Project Consultant Visiting Expert Technical Collaborator 11 20 years > 20 years Mrs. Dr. Others (please state):

Others (please state): __________________________________________ EMPLOYMENT Name of Organisation: Nature of Business: state): ___________________ Position: Government Manufacturing Services R&D

Others (please

A soft copy of this form is available in the BGM Portal http://bgm.mosti.gov.my. Please email back the completed form to bgm@mosti.gov.my.