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CyberSecurity Malaysia Collaboration Program (CCP) Application Form.

1. 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. Ensure that all uploads are clearly marked with the name of your company and the number of the question to which they refer.

Important Note: This is a confidential document and the information entered and submitted as part of this document will be handled with confidentiality.

2. FINANCIAL INFORMATION

2.1 General Company Details

Name of the Company(*)

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Registration Details(*)

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Ownership Structure

Bumiputera Ownership (%)(*)

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Non-Bumiputera Ownership (%)(*)

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Number of Years of Operation(*)

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Total Number of Employees(*)

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Ministry of Finance (MOF) Certificate Status(*)

Yes

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Contact Person(*)

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Address(*)

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City(*)

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Postcode(*)

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State(*)

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Country(*)

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Telephone Number(*)

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Fax Number(*)

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Email Address(*)

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Homepage(*)

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2.2 Authorised Signatories

Name 1(*)

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Position 1 in Company(*)

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Name 2(*)

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Position 2 in Company(*)

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Name 3

Please type your full name.

Position 3 in Company

Please type your full name.

2.3 Financial Capacity

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

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

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2- Company bank statement for the last 3 months(*)

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3- Local Company information

Memorandum and Articles of Association (CTC by SSM)(*)

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Forms 9, 11, 24, 44 and 49 (CTC by SSM)(*)

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4- Foreign Company information

Relevant official forms pertaining to the formation or setup of the company

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Relevant official forms pertaining to Certificate of Incorporation

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Relevant official forms pertaining to Notice of Resolution

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Relevant official forms pertaining to Return of allotment of shares

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Relevant official forms pertaining to Registered address of the company

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Relevant official forms pertaining to Statement of Particulars

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3. PEOPLE, PRODUCTS, PROCESSES and TECHNOLOGY (PPPT)

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

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3.2 Key Management and Professional Staff

Please list the Management Staff and the key Professional Staff in your company (provide as much information as possible) – i. Staff Name; ii) Designation; iii) Qualifications; iv) No. of years in Industry.

(Please identify Bumiputera status for Management Staff)(*)

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3.3 Staff Data

Please provide the following information pertaining to your company’s staff –

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

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Highlight the overall manpower composition and please identify Bumiputera status(*)

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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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3.4 Products and Services

Please list the key products and services provided by your company in this relevant domain and among them highlight the following information –

Which of these products or services are certified in cyber security domain(*)

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Which of these products or services were introduced in the last three (3) years(*)

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For which of these products or services do you provide after sales and maintenance support(*)

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For which of these products or services do you provide customer training(*)

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4. BUSINESS EXPERIENCE

4.1 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 name; ii. Project name and scope of the project; iii. Duration and Value of the project; iv. Key locations covered as part of the project.

(*)

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4.2 Customer References

The current number of active customer accounts and projects for the company -(*)

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Please provide references of customers with whom you worked over the past three (3) years – i. Customer name; ii. Contact person; iii. Contact number; iv. Email Address.

(*)

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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(*)

Please type your full name.

Email Address(*)

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Contact Phone No(*)

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CAPTCHA Verification(*)

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