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CyberSecurity Malaysia Collaboration Program (CCP) Application Form

NOTES FOR FILLING THIS APPLICATION FORM

Please complete all portions of this application form and provide all the supplementary information wherever applicable. The answers must be concise and clear to ensure fast and efficient processing of the application form.
Please upload, where appropriate, supporting documents to provide clarity and credibility to the information provided.
The application form must be signed by an authorized representative of the company.
After submission of the forms, CyberSecurity Malaysia shall review the information for approval.
The respective application shall be contacted in case of any clarifications needed or any additional information required.
This is a confidential document and the information entered and submitted as part of this document will be handled with confidentiality.

CCP Category Partnership(*)

Registered Partner (Registration Fee: RM 1,000) (Annual Fee: RM1,000)Strategic Partner (Registration Fee: RM 3,000) (Annual Fee: RM1,500) Invalid Input

1. COMPANY INFORMATION

1.1 General Company Details

Name of the Company(*)

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Company Registration Number(*)

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Ownership Structure(*)

BumiputeraNon – Bumiputera Invalid Input

Number of Years of Operation(*)

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Ministry of Finance (MOF) Certificate Status(*)

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Address(*)

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Phone Number(*)

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Fax Number(*)

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Website URL(*)

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Company Profile Summary(*)

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1.2 Person in Charge (PIC) Details

PIC Name(*)

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Designation(*)

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Phone Number (Ext)(*)

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Phone Number (H/P)(*)

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Email Address(*)

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2. FINANCIAL INFORMATION

2.1 Financial Parameter Information

Please enclose the following documentation or provide information for the following key financial parameters:

Audited Financial Statements of the company (in case of recent start-ups provide available information)(*)

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Company bank statement for the last 3 months(*)

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Memorandum and Articles of Association (Certified True Copy by SSM)(*)

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Forms 9, 11, 24, 44 and 49 (Certified True Copy by SSM)(*)

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3. SERVICES OR PRODUCTS INFORMATION

Main Services or Products Information

Please key in your main services and/or products as details below:

Consulting Services

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Governance, Risk & Compliance

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Training & Education

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Incident Handling

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Security Risk Assessment

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Distributor /Reseller

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Secure System Development

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Security Testing Services

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Managed Security Services

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New Technology Security

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Data Security

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Identity Management & Access Control

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Digital Forensics

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Business Continuity Management

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Standards & Certifications

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Maintenance & Support

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Others

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3.2 Expertise and Value Proposition

Provide a brief summary of the expertise of the company and its key value proposition in relation to the cyber security domain.(*)

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4. STAFF INFORMATION

4.1 Staff Data

Total number of employees(*)

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Total number of staff with experience in the relevant domain(*)

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Number of technical staff with relevant certifications and training(*)

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Total Number of sales staff and their total gross compensation(*)

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Total number of customer support staff(*)

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4.2 Key Management and Professional Staff

Please list the Management Staff and the key Professional Staff in your company (i. Staff Name; ii. Designation; iii. Bumiputera/Non-Bumi; iv. Qualifications; v. No. of years in Industry)

(*)

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5. BUSINESS EXPERIENCE

5.1 Past Experience

Please list key projects worked on in the cyber security domain over the past three (3) years in collaboration with government agencies or other clients (provide as much information as possible) – i. Client; ii. Project name; iii. Scope of the project and location details; iii. Duration; iv. Value of the project.

(*)

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Additional Information

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SIGN-OFF SHEET

I hereby acknowledge on behalf of the company that the attached documents and information provided in the application form is true to the best of my knowledge. I authorize the use to this information for CyberSecurity Malaysia Collaboration Program (CCP) processing.

Name(*)

Please type your full name.

Position in Company(*)

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Email Address(*)

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Contact Phone No(*)

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CAPTCHA Verification(*)

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