Self Funding Application Form

Borang permohonan bagi individu atas pembiayaan persendirian. / Application form for self-funded individual.

1. Borang ini khusus bagi orang ramai yang berumur 16* tahun ke atas. Walau bagaimanapun, umur minimum bagi permohonan tertakluk kepada syarat-syarat yang dinyatakan bagi program-program tersebut. / Open to public aged 16* years old and above. However, minimum age for application depends on the criteria stated in the programmes.

2. Borang ini digunakan untuk individu yang ingin mendaftar program di atas pembiayaan sendiri. / This application form is for self-funded individuals.

3. Pembayaran yuran program hendaklah dibuat terus kepada pembekal latihan setelah mendapat surat tawaran daripada pembekal latihan tersebut. / The payment fee need to be made directly to the training provider after receiving the offer letter from the training provider.

4. Pembayaran yuran hendaklah dibuat sebelum program dijalankan tertakluk kepada terma dan syarat pembayaran yang dinyatakan oleh pembekal latihan. / Program Fee need to be made before the start of the program depending on the terms and conditions stated by the training provider.

*pada tarikh permohonan / at the time of application.

Nama penuh / Full name *

Seperti yang tertera di dalam Kad Pengenalan / As stated in Identity Card

Warna kad pengenalan/ IC colour *

No. pasport / Passport no.

Bil. Kad pengenalan / Identity card no: *

e.g. 01234567

Tarikh lahir/ Date of birth *

Umur / Age

For example, if you are 30 years old when you are applying for a course on 6th july 2020, then you should write 30.

Jantina / Gender *

Male / Lelaki
Female / Perempuan

Agama / Religion *

Kerakyatan / Citizenship

e.g. Bruneian

Status Perkahwinan / Marital Status *

Sila nyatakan skop kerja awda pada masa ini / Please state your current scope of work *

Bangsa / Race *

Alamat persuratan / Mailing address *

No. telefon / Phone number *

Pejabat / Office
Rumah / Home
Telefon bimbit / Mobile

No. telefon pejabat / Office phone number

No. telefon rumah / Home phone number

No. telefon bimbit / Mobile phone *

Nombor telefon kecemasan / Emergency contact number *

Emel / Email *

Kelulusan akademik tertinggi / Highest academic qualification *

Example: 5 'O' Level Credits (if your highest academic qualification is 'O' Level) / Skills Certificate 3 (SC3), HNTec in Office administration (if your highest qualifications in HNTec) / BSc. (Hons) in Information Technology (if your highest qualification is Degree).

Status Pekerjaan / Job Status *

Sijil Profesional (jika ada) / Professional Certificate (If applicable)

Program yang dipohonkan / Programme that you would like to apply

Nama pembekal program / Name of training provider *

Universiti Brunei Darussalam (UBD)
Universiti Islam Sultan Sharif Ali (UNISSA)
Universiti Teknologi Brunei (UTB)
Politeknik Brunei (PB)
Institute of Brunei Technical Education (IBTE)
SEAMEO VOCTECH
Pusat Pembangunan Belia (PPB)

Nama program yang dipohon / Name of programmes applied

Kohort (Jika ada) / Cohort (If applicable)

Sebab - Sebab Memohon / Reasons for Applying *

Lain - Lain / Others

Nama program / Programme Name *

Name pembekal program yang menjalankan program tersebut / Name of training provider who conducted the programme *

Sila nyatakan jika awda mempunyai sebarang penyakit kronik / Please state if you have any chronic disease

Adakah anda mempunyai sebarang ketidakupayaan atau kelemahan fizikal? / Do you have any disabilities or physical impairment?

Muat Naik Dokumen-Dokumen / Upload Documents *

Sila sertakan dokumen sokongan seperti berikut / Please attach the following supporting documents:
- Gambar Passport / Passport Photo
- Salinan sijil berhenti sekolah / Copy of school leave certificate
- Salinan Kad Pintar / Copy of Identity Card
- Salinan Passport / Photocopy Passport
- Salinan sijil-sijil kelulusan akademik / Copy of academic certificate

Pengakuan / Declaration

• Saya mengesahkan bahawa semua maklumat yang diberikan di atas adalah lengkap dan betul. Saya juga memahami bahawa Pusat Pembelajaran Sepanjang Hayat (L3C) mempunyai hak untuk menangguhkan atau membatalkan program menurut budi bicara dan keputusan pengurusan L3C itu sendiri. I confirm that all the information given above is complete and correct. I also understand that Lifelong Learning Centre has the right to postpone or cancel the program upon the discretion and decision of L3C management.

• Saya dengan ini membenarkan L3C untuk menggunakan, tanpa sekatan atau saraan, untuk pendidikan, promosi, atau proses pengambilan pelajar, mana-mana pita video, gambar, imej dari program, atau media elektronik yang dihasilkan oleh seorang jurugambar bagi pihak L3C, kakitangan L3C, atau / dan pasukan komunikasi L3C. I do hereby permit L3C to use, without restriction or remuneration, for education, promotion, or student recruitment process, any videotape, photographs, images from programme, or electronic medium produced by a photographer on behalf of L3C staff member, or / and LC3 Communication Team.

Setuju/ Agree *

Ya / Yes