MSTH Q-Cap Training Application (Individual)

* indicates required fields


Certification Program *
Preferred Training Date *

Applicant's Information

First Name *
Last Name *
Date of Birth *
Select a date from the calendar.
e.g 31/12/1970
Identification Card / Passport Number *
Supporting Document Type the Web address: (Click here to test)  

Type the description: 

Supporting Document *Upload a Copy of Your IC Here
We need a copy of your Identification Card (IC) in order to process your application.
Use the link above to upload a copy of your IC. You can also e-mail it to us at or fax to us at +603-89965405.
Click here to view your uploaded IC
Nationality *
Gender *
Race *
Address *
ZIP/Postal Code *
City *
State *
Country *
Phone Number *
E-mail *
Working Experience

Education Information

Highest Qualification *
Institute / University *
Graduation Date
Select a date from the calendar.
CTFL Certification Number (if applicable)

Employment Information

Company Name
Company Address
ZIP/Postal Code
Designation *
Nature of Business

Declaration of Applicant

*I declare that the information provided in this application is true and correct. I understand that my application is subject to MSTB evaluation and approval
 I agree to become a Q-Portal Professional Member 

Declaration of Personal Data Protection Act (PDPA)

Please tick (✓) in the appropriate boxes
(* Compulsory and necessary for successful registration)
* I/We have read and agree to the Terms and Conditions, and Statement of Privacy.
Saya/Kami telah membaca dan bersetuju dengan Syarat-syarat dan Peraturan(versi bahasa inggeris) serta Kenyataan Privasi.
* I/We hereby give my/our consent for MSTB to retain information provided in this form for the purpose of registration and communications related to my membership to Q-Portal.
Saya/Kami dengan ini membenarkan MSTB untuk meyimpan maklumat yang dinyatakan di dalam borang ini untuk tujuan pendaftaran dan komunikasi berkaitan keahlian Q-Portal.
I/We hereby give my/our consent for MSTB and/or its appointed agent to contact me/us for the purposes of providing update on and/or invitation to participate in future activities that may be of interest to me/us.
Saya/Kami dengan ini membenarkan MSTB dan/atau ejen dilantik untuk menghubungi kami untuk mengemaskini maklumat dan/atau menyampaikan undangan untuk aktiviti-aktiviti di masa hadapan yang mungkin bersesuaian dengan saya/kami.
  Should you wish to cease receiving such communications, please inform MSTB through email:
Sekiranya anda tidak lagi berhasrat untuk menerima sebarang komunikasi, anda boleh menghubungi MSTB melalui emel: