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P.U.

173/66
COMPANIES REGULATIONS, 1966
SECOND SCHEDULE (Regulation 3)

FORM 48A. Statutory Declaration By A Person Before Appointment As


Director, Or By A Promoter Before Incorporation Of Corporation.

FORM 48A
Companies Act, 1965
(Section 16 (3A) and 123 (4) )

Company No.

STATUTORY DECLARATION BY A PERSON BEFORE


APPOINTMENT AS DIRECTOR, OR BY A PROMOTER
BEFORE INCORPORATION OF CORPORATION

...................................... (NAME OF COMPANY)

I, ...................................... *I/C No. /*Passport


No. ...................................... of ...................................... do solemnly and sincerely declare that -

(1) 1 am not an undischarged bankrupt.

(2) 1 have not been convicted whether within or without Malaysia of any offence

(a) in connection with the promotion, formation or management of a corporation;


(b) involving fraud or dishonesty punishable on conviction with imprisonment for three months
or more, or
(c) under section 132, 132A or under section 303, within a period of five years preceding the
date of this declaration.
(3) I have not been imprisoned for any offence referred to in paragraph (2) hereof within the period of
five years immediately preceding the date of this declaration.

*(4) 1 am an undischarged bankrupt but have been granted leave by the court under section 125 to
act as a director of ...................................... (name of corporation) .

*(5) 1 have been granted leave by the court under section 130 to be director
of ...................................... (name of corporation) or a promoter of a proposed
corporation...................................... (name of proposed corporation) or both a director
of...................................... (name of corporation) and a promoter of ......................................
(name of proposed corporation) . I attach herewith an office copy of the court order.

(6) 1 hereby consent to act as director of...................................... (Nama Syarikat) .

And I make this solemn declaration conscientiously believing the same to be true, and by virtue of the
provisions of the † Statutory Declarations Act, 1960.

Subscribed and solemnly declared by the


abovenamed ...................................... at...................................... in the State
of ...................................... this...................................... day
of ...................................... ,19......................................

Before me

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

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