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    Form PFF Application Qualifying Exam Practice Pharmacy Okt 2014

    Uploaded by

    Sakinah Azmi
    This document contains an application form for the Qualifying Examination for Registration as a Practising Pharmacist in Malaysia. The form requests information such as the applicant's personal details, qualifications, training details, and registration details if applicable in other countries. It also contains instructions for applicants on how to submit the completed form and contact details for inquiries. Applicants must ensure all required documents are certified and attached before submitting the application for consideration.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Form PFF Application Qualifying Exam Practice Pharmacy Okt 2014

    Uploaded by

    Sakinah Azmi
    131 views6 pages
    This document contains an application form for the Qualifying Examination for Registration as a Practising Pharmacist in Malaysia. The form requests information such as the applicant's personal details, qualifications, training details, and registration details if applicable in other countries. It also contains instructions for applicants on how to submit the completed form and contact details for inquiries. Applicants must ensure all required documents are certified and attached before submitting the application for consideration.

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    Original Title

    Form Pff Application Qualifying Exam Practice Pharmacy Okt 2014

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    This document contains an application form for the Qualifying Examination for Registration as a Practising Pharmacist in Malaysia. The form requests information such as the applicant's personal details, qualifications, training details, and registration details if applicable in other countries. It also contains instructions for applicants on how to submit the completed form and contact details for inquiries. Applicants must ensure all required documents are certified and attached before submitting the application for consideration.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    131 views6 pages

    Form PFF Application Qualifying Exam Practice Pharmacy Okt 2014

    Uploaded by

    Sakinah Azmi
    This document contains an application form for the Qualifying Examination for Registration as a Practising Pharmacist in Malaysia. The form requests information such as the applicant's personal details, qualifications, training details, and registration details if applicable in other countries. It also contains instructions for applicants on how to submit the completed form and contact details for inquiries. Applicants must ensure all required documents are certified and attached before submitting the application for consideration.

    Copyright:

    © All Rights Reserved
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    (PFF)

    PERMOHONAN MENDUDUKI PEPERIKSAAN KELAYAKAN UNTUK MENGAMAL


    FARMASI
    APPLICATION FOR QUALIFYING EXAMINATION FOR REGISTRATION AS A PRACTISING PHARMACIST IN MALAYSIA

    (Borang/ Dokumen Yang Perlu Disertakan)


    (Form/ Documents to be Attached)
    KEGUNAAN PEJABAT
    (FOR OFFICE USE ONLY)

    SENARAI SEMAK UNTUK DIISI OLEH PEMOHON


    (Sila tandakan )
    CHECKLIST TO BE COMPLETED BY APPLICATNS
    (Please mark /)

    1.

    Ada

    Tiada

    Yes

    No

    Tarikh Terima:

    Borang Permohonan Peperiksaaan


    Kelayakan Untuk Mengamal Farmasi
    yang lengkap diisi

    Cop terima

    Qualifying Examination for registration as a practising pharmacist


    in Malaysia application form

    2.

    Salinan Ijazah yang disahkan.


    Certified copy of degree

    3.

    Salinan Sijil Pendaftaran Luar Negara


    yang disahkan (Jika Ada)
    Certified copy of Overseas Registration Certificate (if any)

    4.

    Tarikh Lengkap:

    Salinan surat Perjanjian Menjadi


    Murid (Borang 10)/Akuan Menjalani
    Latihan dalam atau luar negara
    yang disahkan

    Disemak oleh:
    Nama:
    Tarikh :

    Certified copy of Agreement form (Form 10)


    /Proof of Training in Malaysia or overseas

    5.

    Salinan Kad Pengenalan/Surat


    Daftar Beranak /Pasport yang disahkan

    Masuk Data Dalam Komputer:

    Certified copy of Identity Card/Birth certificate/Passport

    6.

    Alamat di Malaysia yang terkini


    Malaysian Current Address

    7.

    Nama:
    Tarikh :

    No. telefon yang boleh dihubungi


    Contactable telephone number

    8.

    Salinan sijil perkahwinan & Permit Kerja


    pasangan/sendiri (jika berkenaan)
    Marriage Certificate and work permit
    of your own/spouse

    NOTA/NOTE:
    1.
    Salinan sijil-sijil, ijazah atau dokumen lain yang berkaitan hendaklah disahkan oleh Ahli
    Farmasi Berdaftar di Malaysia atau Pengamal Perubatan Berdaftar di Malaysia dengan
    mencatatkan Nombor Pendaftaran dan Pengekalan Amalan Tahunannya. Pengesahan
    dari Pegawai Kumpulan Pengurusan dan Profesional, Majistret, Jaksa Pendamai juga boleh
    diterima.
    Copies of certificates, degree or other relevant documents must be certified by a Malaysian Registered Pharmacist or
    Malaysian Registered Medical Practitioner, stated with their registration no. and their annual practising retention no.
    Certification by a Professional Management Group of Government Officer, a Magistrate, and a Justice of Peace can
    also be accepted.

    2.

    Pihak Urusetia berhak menolak permohonan jika tidak lengkap dan dikembalikan kepada
    pemohon.
    The secretariat has the right to reject any incomplete application and shall be returned to applicant.

    Qualifying Examination for Registration as a Practising Pharmacist in Malaysia/ Oct2014

    LEMBAGA FARMASI MALAYSIA


    KEMENTERIAN KESIHATAN MALAYSIA

    SETIAUSAHA
    Lembaga Farmasi Malaysia
    Bahagian Amalan & Perkembangan Farmasi
    Kementerian Kesihatan Malaysia
    Beg Berkunci No: 924
    Pejabat Pos Jalan Sultan
    46790 PETALING JAYA
    Tuan / Sir,
    PERMOHONAN UNTUK MENDUDUKI PEPERIKSAAN KELAYAKAN UNTUK MENGAMAL FARMASI
    BAGI BULAN...........................................
    APPLICATION FOR THE QUALIFYING EXAMINATION FOR REGISTRATION AS A PRACTISING
    PHARMACIST IN MALAYSIA FOR THE MONTH OF
    1.

    BUTIR-BUTIR PEMOHON (Personal Particular)

    Nama

    Name

    Alamat Surat Menyurat :


    Postal Address

    Poskod:

    Negeri:

    Postcode:

    State:

    No. Kad Pengenalan :

    Warna:

    Identity Card No:

    Colour:

    Umur:

    Tarikh Lahir:

    Age:

    Date of Birth:

    Qualifying Examination for Registration as a Practising Pharmacist in Malaysia/ Oct2014

    Warganegara:
    Citizenship:

    Tandakan () (Tick)
    Jantina

    Taraf Perkahwinan

    Sex

    Maritial Status

    Perempuan

    Bujang

    (Female)

    (Single)

    Lelaki (Male)

    Berkahwin
    (Married)

    No. Telefon:

    No. Telefon Bimbit (Jikaada):

    Telephone No:

    H/Phone No. (If available)

    No. Faks (Jika ada)


    Fax No. (If available)

    E-mail (jika ada): ...


    (If available)

    2. UNTUK DIISI OLEH WARGA ASING (To Be Filled By Foreigner)


    No. Pasport (Jika Bukan Warganegara):

    Tarikh Tamat pasport:

    Pasport No

    Expiry Date:

    No. Pendaftaran Perkahwinan:

    Negara Didaftarkan:

    Marriage Registration No.

    Country Registered:

    No. Permit Pekerjaan (Jika ada):


    Work Permit No. (If available)

    Tarikh Tamat Permit Kerja:


    Work Permit Expiry Date:

    3. BUTIR-BUTIR SUAMI/ISTERI (JIKA BERKAITAN): [Spouse's Particulars (If Applicable]


    Nama Suami/Isteri:
    Name of Spouse:

    No. Kad Pengenalan:

    Warna:

    Identity Card No:

    Colour:

    Qualifying Examination for Registration as a Practising Pharmacist in Malaysia/ Oct2014

    No. Pasport:

    Warganegara:

    Pasport No:

    Citizenship:

    Pekerjaan:
    Ocupation

    Alamat Majikan:
    Employer:

    Poskod:

    Negeri:

    Postcode:

    State:

    No. Telefon:

    No. Telefon Bimbit: (jika


    H/Phone No (if available)

    Telephone No

    ada):

    No. Faks (jika ada)


    Fax No. (If available)

    E-mail (Jika ada): ...........................................................................................


    E-mail (If available)

    4.

    BUTIR-BUTIR KELAYAKAN :( Qualification)


    Kelayakan/kelulusan:

    Tarikh Diperolehi:

    Degree

    (Date graduated)

    Tandakan () (Tick)
    a.

    Program Berkembar (Twinning)/Francais

    b.

    Sepenuh Masa Di Malaysia (Full Time in Malaysia)

    c.

    Sepenuh Masa Di Luar Negara (Full Time Overseas)

    Nama Universiti/Institusi:
    University

    Qualifying Examination for Registration as a Practising Pharmacist in Malaysia/ Oct2014

    5.
    5.1

    TARIKH MENJALANI LATIHAN: Housemanship/Pupillage


    Tempat/Alamat Latihan:
    Place/Address

    a
    b
    Mula:

    Tamat:

    Started:

    Finished:

    a
    5.2

    Tempat/Alamat Latihan:
    Place/Address

    a
    b
    Mula:

    Tamat:

    Started:

    Finished:

    6.

    BUTIR-BUTIR PENDAFTARAN SEBAGAI AHLI FARMASI DI LUAR NEGARA (Jika Ada):


    (If registered in other country)(If applicable)

    No. Pendaftaran

    Negara Didaftarkan

    Registration No:

    Country Registered:

    Tarikh diperolehi:
    Date:

    Tarikh:
    (Date)

    ..................................

    .........................................

    (Tandatangan Pemohon)
    (Applicants Signature)

    Qualifying Examination for Registration as a Practising Pharmacist in Malaysia/ Oct2014

    PANDUAN UNTUK PEMOHON


    1.

    Borang yang diisi lengkap hendaklah dialamatkan kepada:


    SETIAUSAHA
    Lembaga Farmasi Malaysia
    Bahagian Amalan & Perkembangan Farmasi
    Kementerian Kesihatan Malaysia
    Beg Berkunci No: 924
    Pejabat Pos Jalan Sultan
    46790 PETALING JAYA

    2.

    Borang permohonan boleh diperolehi daripada:

    a)

    Bahagian Amalan & Perkembangan Farmasi (seperti alamat di atas)

    b)

    Laman web www.pharmacy.gov.my

    3.

    Sebarang pertanyaan boleh diajukan kepada Bahagian Amalan &


    Perkembangan Farmasi atau menghubungi nombor berikut: 03-78413261(Puan
    Nurul Afifah Osman) atau 03-78413319 (Puan Norlela Joned) atau melalui
    email: [email protected]

    GUIDELINES FOR APPLICANTS


    1.

    A completed form must be sent to:

    Secretary
    Pharmacy Board of Malaysia
    Ministry of Health Malaysia
    Lot 36, Jalan Universiti
    46350 Petaling Jaya
    Selangor, Malaysia
    2.

    The application form can be obtained from


    a)
    b)

    3.

    Pharmacy Practice & Development (as the above address)


    Website (www.pharmacy.gov.my)

    For any inquiries, please contact Pharmacy Practice & Development or contact
    the following numbers 03-78413261(Puan Nurul Afifah Osman) or 03-78413319
    (Puan Norlela Joned) or email us at: [email protected]

    Qualifying Examination for Registration as a Practising Pharmacist in Malaysia/ Oct2014

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