BORANG D

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Telephone:
Fax:
Website:
Email:
Students Unit
(020 7402 0045)
Students Hostel
(020 7402 0953)
020 7262 8406
www.upp.org.uk
[email protected]
SURUHANJAYA TINGGI NEGARA BRUNEI DARUSSALAM
HIGH COMMISSION OF BRUNEI DARUSSALAM
(STUDENTS UNIT)
35 – 43 Norfolk Square
London W2 1RX
ACADEMIC STATUS FORM PRIVATE STUDENT
ASFP
SESSION _______________
A.
REGISTRATION:
1.
NAME: _______________________________________________________________
2.
TYPE OF SCHOLARSHIP
PHOTOGRAPH
Please tick ( √ ) the appropriate box and quote your reference number
2.1 PRIVATE STUDENT
PN/ _____________________
2.2 PRIVATE STUDENT
PR/ _____________________
(BRUNEI PERMANENT RESIDENCE – NON YELLOW IC HOLDER)
2.3 MINISTRY OF DEFENCE
MOD/____________________
2.4 JABATAN PERANCANGAN DAN
JPKE/ ___________________
KEMAJUAN EKONOMI
2.5 BRUNEI SHELL PETROLEUM
BSP/ ____________________
2.6 BRUNEI SHELL TANKERS
BST/ ____________________
2.7 BRUNEI GAS CARRIERS
BGC/ ___________________
2.8 TOTAL EDUCATION SPONSORING
TESS/ ___________________
SCHEME
3.
CONTACT ADDRESS / TELEPHONE NUMBERS / E-MAIL
3.1. ADDRESS (U.K. OR EIRE)
.
4.2. ADDRESS (BRUNEI DARUSSALAM)
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
POST CODE _______________________
POST CODE ___________________
TEL NO
_______________________
TEL NO
_______________________
MOB NO
_______________________
E-MAIL
_______________________
4. CONTACT PERSON INCASE OF EMERGENCY ______________________ TEL NO _____________
5.
DATE OF BIRTH
: _____________________
PLACE OF BIRTH : _____________________
6.
RELIGION
: _______________________
GENDER
: MALE / FEMALE
7.
RACE
: _______________________
NATIONALITY
: ______________________
8.
BRUNEI.IC.NO
: _______________________
COLOUR
: ______________________
9.
MARITAL STATUS : _______________________
10. PASSPORT NO
(IF MARRIED, NO OF CHILDREN__________)
: __________ DATE OF ISSUE : ___________ DATE OF EXPIRE : __________
11. VISA EXPIRY DATE : _______________________________________________________________
12. CERTIFICATE OF REGISTRATION AS A PRIVATE STUDENT WITH MINISTRY OF EDUCATION,
NEGARA BRUNEI DARUSSALAM
B.
RERERENCE NO
: ____________________________________________________________
CERTIFICATE DATE
: _________________ CERTIFICATE EXPIRY DATE : _________________
ACADEMIC REPORT
PLACE OF STUDY
DEPARTMENT / FACULTY
ADDRESS
NAME OF COURSE
YEAR OF COURSE
COURSE LEVEL
DATE OF SESSION
COMMENCE
DATE / YEAR EXPECTED TO
COMPLETE COURSE
DURATION OF COURSE
_____________________ YEARS
2
C.
PARTICULARS OF PARENTS / GUARDIAN:
REFERENCES
FATHER
MOTHER
FULL NAME
OCCUPATION
NAME AND ADDRESS OF
EMPLOYER
OFFICE TELEPHONE NO.
HOME ADDRESS IN
BRUNEI
TELEPHONE IN BRUNEI
PLEASE STATE IF
DECEASED
NOTE:
Please enclose all the documents stated below upon submitting the completed forms:
o
Certificate of Registration from Ministry of Education – (Private student only)
o
Acceptance Letter from your School / College / University
o
Statutory Declaration – (Private student only)
o
Bank Statement of sponsor letter from your Guarantor
o
2 passport size photographs (write your name at the back of the photographs)
o
Copy of student passport – front page and visa
o
Copy of Student Identity Card
IMPORTANT:
Failing to submit all the required documents will delay the process of issuing your private student card
STUDENT’S SIGNATURE : ___________________________ DATE : ________________________
3
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