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Application For Retention of Name

This document is an application form for nurses to apply for retention of their name on the Nursing Board of Malaysia register while working abroad. It requests information such as the applicant's full name, registration number, ID/passport number, designation, home and contact addresses, application period, and reason for working abroad including the hospital address. It specifies the payment amounts of RM25 per year for registered nurses and RM10 per year for registered community/assistant nurses. Payments must be made via postal order or bank draft to the Secretary of the Nursing Board of Malaysia along with a photocopy of the nurse's registration certificate.

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Natyra Rani
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6K views2 pages

Application For Retention of Name

This document is an application form for nurses to apply for retention of their name on the Nursing Board of Malaysia register while working abroad. It requests information such as the applicant's full name, registration number, ID/passport number, designation, home and contact addresses, application period, and reason for working abroad including the hospital address. It specifies the payment amounts of RM25 per year for registered nurses and RM10 per year for registered community/assistant nurses. Payments must be made via postal order or bank draft to the Secretary of the Nursing Board of Malaysia along with a photocopy of the nurse's registration certificate.

Uploaded by

Natyra Rani
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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application_for_retention_of_name_-_english_and_malay_version.

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LEMBAGA JURURAWAT MALAYSIA
URSING BOARD MALAYSIA
KEMENTERIAN KESIHATAN MALAYSIA
INISTRY OF HEALTH MALAYSIA
ARAS 3, BLOK E1, PARCEL E
LEVEL 3,BLOCK E1, PARCEL E
PUSAT PENTADBIRAN KERAJAAN PERSEKUTUAN
FEDERAL GOVERNMENT ADMINISTRATIVE CENTRE
62590 PUTRAJAYA
BKJ -BOR-DAF/APC-03
T e l
: 03-88906025
F a x
: 03-88831329
Secretary,
DIVISION 11 - SECTION 12 (1)
Nursing Board Malaysia, Ministry Of Health Malaysia, Level 3, Block E1 Parcel E Federal
Government Administrative Centre 62590 Putrajaya. Date:



APPLICATION FOR RETENTION OF NAME.
1. Full Name
2.Registration Number: ..
3. Identity Card No./ Passport
4. Designation:
5. Home Address
..
.
6. Telephone No: House)(Mobile).
7. Application Period:
From.Till..
8. Reason for Application:..
i) Give the reason to work abroad.
ii) Hospital address abroad
..
..
Total payment:
Signature:
Date:
D a t e : 1 E a c h A p p l i c a t i o n m u s t b e
a c c o m p a n i e d b y a P h o t o s t a t c o p y o f N u r s e
R e g i s t r a t i o n C e r t i f i c a t e / c u r r e n t A n n u a l
P r a c t i c i n g C e r t i f i c a t e ( M a l a y s i a ) 2 . P a y m e n t o f
- R M 2 5 . 0 0 p e r y e a r

R e g i s t e r e d N u r s e - R M - 1 0 . 0 0 p e r Y e a r

R e g i s t e r e d C o m m u n i t y N u r s e / A s s i s t a n t
N u r s e 3 . P a y m e n t t o b e m a d e v i a P o s t a l O d e r
o r B a n k D r a f t o n l y a n d t o p a y t o t h e S e c r e t a r y
o f N u r s i n g B o a r d M a l a y s i a .

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