BMW Club Malaysia

(Kelab BMW Malaysia) Reg no: 1175-06-SEL

URL: http://www.bmwclubmalaysia.com
A503, Kelana Square, SS7/26, Kelana Jaya,
47301 Petaling Jaya, Selangor

MEMBERSHIP APPLICATION / RENEWAL FORM

New Membership Application Membership Renewal (For Renewal, fill-in details which had been changed ONLY)

A. Personal Details

Name (as in NRIC/Passport) Mr Ms Mdm Others

NRIC/Passport No. BMW Club Forum Nickname

Birth of Birth - - Gender Male Female Shirt Size

(DD-MM-YYYY)

Place of Birth Marital Status Single Married

Race Malay Chinese Indian Others (Please Specify)

Citizenship Citizen Permanent Residence Others (Please Specify)

Nationality Malaysian Others (Please Specify) Religion

Correspondence Address Contact Number

Mobile
Home
Office
Postcode Town/City E-Mail Address
State Country Occupation / Designation
B. Vehicle Details
Vehicle Registration No. Registration Year CKD Imported

Model Code Engine capacity cc Color Auto Manual

C. Declaration
By submitting this application and subject to approval of my membership of BMW Club Malaysia (BCM), I agree to be bound by the rules and regulation of BCM herewith and hold BCM
harmless in all respects arising from my actions, which are not in line with the objectives of BMC. I also agree that any and all actions and representations made without the express
approval of the BCM and/or its elected office bearers are personal actions and re presentations and BCM shall not be held liable in all respects.

Signature Date Introducer Name (If Any)

D. Administration (For Administrator Use ONLY)

Received by (date) : ( ) Membership No: BCM

Approved by (date) : ( ) Validity Period : / / to / /

Payment Received by : Disclaimer

Submission of the application form and payment of registration and membership fees is not proof of
Cheque Remarks: acceptance of membership. BCM has the right to rejust any application without disclosing the reasons
therewith. Applicant will be duly notified by BCM of the status of their application through email/phone
Cash
within 2 weeks of application and duly return the registration and membership fee should your
Bank-in application be rejected

Registration fee: RM150.00 Annual Membership Fee: RM150.00

Cheque Payment:
All Cheques should be crossed (Not Negotiable A/C payee only) to Kelab BMW Malaysia (BMW Club Malaysia)
Please include the appropriate cheque clearance commision for out-station cheque
Cash Deposit:
Maybank Bank Account: 512532307612 (Cheque/Cash Deposit & Bank-in- Slips should be sent to BCM’s mailing address above)
By Hand (Cash):
Registration form and cash money should be submitting directly to any BCM committee member