MEMBERSHIP APPLICATION FORM

New Application Renewal/Info updates For Year: 2018

Membership Fee:

Ordinary
Class Class A Class B Class C Associate International
Entrance Fee 500 500 500 500 1,500
Yearly Subscription Fee 300 300 200 200 500

(** Applicants will be advised of membership category after submission of documents and acceptance of
application)

Payment:
Cheque to be made payable to “MAESCO”

And to be forwarded to our Secretariat office at:

MAESCO
No 9, Jalan SS7/10
Kelana Jaya, 47301 Petaling Jaya, Selangor Darul Ehsan
Tel: 03-7873 0784 Fax: 03-7873 0769

*We consent to the publication of our company name as MAESCO member (when approved) in the
MAESCO website.

Date:________________________ Signature:________________________

(For MAESCO Committee review purposes only)

Proposed by: ....................................................Post: ................................... Date: ..................

Seconded by: ...................................................Post: ....................................Date: .................

Approved/Not Approved: ............................................ Date: ..................

Remarks:
 1 Company Background
1(a) Name of Company & No

1(b) Registered address

Telephone & Fax no

1(c) Business / Correspondence Address

Telephone & Fax no

1(d) Authorised Capital RM

Paid up capital RM

Incorporation date

Directors 1)

2)

3)

(Please attach form 24, 49, 9 & M&A)

1(d) Chief Executive’s Name with mobile,

telephone, fax nos. & e-mail

1(e) Name, designation, address, mobile,

telephone, fax nos. & e-mail of
responsible person who could be
contacted in connection with the
application
 2 Organisational set up
2(a) What is your nature of works and services undertaken? Give brief description about your
company/organisation

2(b) Please attach a simple schematic diagram showing the Organisation Structure and
describe overall management structure

3 Works/service undertaken/offered in the field of energy by your organisation:

3(a) Please describe the works and services offered in the field of Energy
(Example: Energy Auditing, energy equipment manufacture, contractor, consultancy, etc.)

3(b) Please describe other works/services undertaken/offered by your organisation:

4 Experience in energy efficiency

4(a) Does your organisation have an Energy Audit (EA) Cell? If yes, who heads the EA Cell?
Whether energy conservation is his exclusive or additional responsibility? To whom he is
reporting?

Give salient features of EA Cell’s constitution, functions, amount of finances available,

achievements, future plans and strategy followed to undertake energy auditing/efficiency
programmes.

4(b) Number of audits conducted

4(c)
Number of recommendations implemented
4(d) Type and number of audit instruments
available

5 Implementation
5(a)
No. Of Projects completed
5(b) Performance guaranteed:
No. of projects and project details:

Shared Savings Projects:

No. of projects and project details:

6 Sectors
6(a) Describe various sectors to whom services
provided by your organisation (Eg.
Buildings-Hotels, Hospitals, Shopping Malls
etc., Industrial-Cement, Aluminium, Pulp &
Paper etc.)

7 Professional Competence
7(a) Cvs of staff (professionals) in energy
efficiency

7(b) Competence of staff in Design Engineering

Applications for various clients

8 Finance
20_____ 20_____ 20______
Financial Year
(RM) (RM) (RM)

Turnover-Energy Related

Turnover - others

9 Any other relevant information:

10 Other Supporting Documents : a. Company profile & Product Brochure