PERSATUAN KESELAMATAN, KESIHATAN PERKERJAAN DAN ALAM SEKITAR SABAH

SABAH OCCUPATIONAL SAFETY, HEALTH AND ENVIRONMENT ASSOCIATION

SOSHEA (PPM-002-12-04052016)

Membership Form

(For office use only) PHOTO

Registration No: / /

Full Name (according to IC):

Identification Certificate No:
Date of Birth:
Place of Birth:
Residential Address:

Correspondence Address:

Qualification:
Safety Experience:

Name of Employer:
Office Contact:
Home Contact:
Mobile No:
Email Address:
Introduced by:
Signature of Applicant:

Date:

For office use only:

Received by:
Date:
Membership Category:
Approved by:
Date:
Membership Fees: Individual member – RM50.00 (1 year) RM120.00 (3 years)
Student member – RM30.00
Life member – RM1,000.00 (one time payment)
Processing Fee: RM50.00