EMBASSY OF MALAYSIA, PARIS Recent

Pasport
Registration No. _________________ Size
(Pin.Spt. Ruj.KONS.658/2002 bth 20.08.02) Photograph

A. PERSONAL PARTICULARS

1. Name : _____________________________________________________________________

2. Other Name:_________________________________________________________________

3. Date & Place of Birth : ________________________________________________________

4. Sex: ______________ Religion:_____________________________________________

5. Old Identity Card No.:_______________ New Identity Card No.:_______________________

6. Passport No.:_____________________Expiry Date: _________________________________

7. Date & Place of Issue:_________________________________________________________

8. Birth Certificate No.:________________Date/Place of Issue:__________________________

B. FAMILY PARTICULARS

9. Marital Status:________________ Name of Spouse :_________________________________

10. Nationality: _______________________________No. of Children : ____________________

Children Particulars:

Name: Date/Place of Birth Passport/BC No.

1.

2.

3.

4.

C. PARTICULARS IN MALAYSIA (next of kin/address to be contacted)

11. Name :_____________________________________________________________________

12. Permanent address in Malaysia: _________________________________________________

___________________________________________________________________________

13. Telephone No: ____________________________Fax No:____________________________

14. Occupation/Working Address:___________________________________________________

________________________Telephone: ___________________Fax:___________________
D. PARTICULARS IN PRESENT COUNTRY - FRANCE / PORTUGAL*

15. Date of First Arrival: _________________ Duration of Stay: __________________________

16. Address: ____________________________________________________________________

17. Telephone No: _______________________E-mail Address:___________________________

18. Type and Visa No: / Permit of Stay No: ___________________________________________

19. Date of Issue : ________________________Expiry Date: _____________________________

E. PURPOSE OF RESIDENCE IN PRESENT COUNTRY

Employment :

20. Name & Address of Employer:__________________________________________________

21. Occupation:___________________Tel. & Fax No:__________________________________

22. Working Permit No: _________________________Valid Until: _______________________

Education / Courses:

23. Course/Level of Study:_________________________________________________________

24. Name of University/Instituion:___________________________________________________

25. Address: ____________________________________________________________________

26. Duration of Course: ______________Expected date of Completion:_____________________

27. Previous Education in Malaysia : ________________________________________________

28. Sponsor:____________________________________________________________________

Other than the above (accompanying spouse / parents / guardian / secondment / research / etc)

29. ___________________________________________________________________________

30. Person to contact in emergency cases :

In France: __________________________________________________________________

___________________________________________________________________________

Elsewhere: _________________________________________________________________

__________________________________________________________________________

Signature: _______________________________E.O.M Paris Dated:_________________________

Name: ( )

IMPORTANT: All registered citizen at the Embassy of Malaysia in Paris are hereby advised to
inform the Embassy should they leave France for good or moving to the new address.