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UNIVERSITI BRUNEI DARUSSALAM APPLICATION FORM (Postgraduate Diploma/Postgraduate Certificate/Masters/Ph. D Programmes). Sila kembalikan borang yang telah lengkap diisikan bersama dokumen yang telah disahkan kepada : Please return completed forms together with certified

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Universiti brunei darussalam application form

UNIVERSITI BRUNEI DARUSSALAM

APPLICATION FORM

(Postgraduate Diploma/Postgraduate Certificate/Masters/Ph. D Programmes)

Sila kembalikan borang yang telah lengkap diisikan bersama

dokumen yang telah disahkan kepada :

Please return completed forms together with certified

copies of relevant documents to :

The Registrar & Secretary

Universiti Brunei Darussalam

Jalan Tungku link

Gadong BE 1410

Brunei Darussalam

/

Applicant’ Name

First Choice :

Programmes

Applied

Second Choice :

Status

Government Employee

Name of Ministry/Department :

Private Sector Employee

Name of Comapny :

Pre-Service

I. C. No :

Colour :


Universiti brunei darussalam application form

PANDUAN MENGISI DAN MENGHANTAR BORANG PERMOHONAN

A GUIDE ON FILLING IN AND SUBMITTING TE APPLICATION FORM

1.

Pemohon mestilah mengisi Borang Permohonan Asal dalam dua (2) salinan

Applicants are required to fill in two (2) copies of Application form.

2.

Setiap borang hendaklah dilengkapi dengan salinan-salinan dokumen yang telah disahkan oleh ketua jabatan/pengetua/

guru besar/pengurus syarikat seperti berikut :

Each application form must be attached with copies of certified documents as follows:

a) Salinan Surat Beranak. / Copy of Birth Certificate

b) Salinan Kad Pengenalan. / Copy of Identity Card

c) Salinan sijil ijazah pertama/sarjana./ Copies of Higher National Certificate/Diploma/First Degree/Masters Degree

d) Salinan sijil/dokumen lain yang berkaitan./ Other copies of relevant academic certificates / documents

3.

Setiap borang hendaklah dilekatkan dengan gambar terbaru berukuran pasport.

Each form is to be attached with a recent passport size photograph

4.

Pemohon-Pemohon lain bolehlah menghantar borang permohonan terus ke Bahagian Kemasukan dan Rekod Pelajar,

Tingkat Satu, Bangunan Pentadbiran, Universiti Brunei Darussalam.

Completed application form must be sent to:

Admission & Students Records Section,

1st. Floor, Administration Block,

Universiti Brunei Darussalam,

Jalan Tungku-Link, Gadong BE1410,

Negara Brunei Darussalam.

Nota /Notes:

1. Universiti Brunei Darussalam berhak menolak borang permohonan yang tidak lengkap atau mengandungi maklumat

palsu.

Universiti Brunei Darussalam reserves the right to reject application forms which are INCOMPLETE, RECEIVED

AFTER THE CLOSING DATE OR CONTAINING FALSE INFORMATION.

2. Pemohon-pemohon yang disenaraipendekkan/berjaya sahaja yang akan dihubungi.

Only successful applicants will be contacted.


Universiti brunei darussalam application form

BORANG PERMOHONAN

(Program Diploma Lepas Ijazah/Sijil Lepas Ijazah/Sarjana/Doktor Falsafah)

APPLICATION FORM

(Postgraduate Diploma/Postgraduate Certificate/ Masters/ Ph. D Programmes)

Lekatkan

Gambar Ukuran Pasport di sini /

Attach Passport size

Photograph

here

/

UNIVERSITI BRUNEI

DARUSSALAM

Program Dipohon : Kod/Code Nama Program dengan lengkap / Name Of Programme in full

Programme Applied :

Pilihan Pertama/

First Choice Pilihan Kedua/

Second Choice

[ Sepenuh Masa/Full-Time ] *

[ Separuh Masa/Part-Time ]

[ Sepenuh Masa/Full-Time ] *

[ Separuh Masa/Part-Time ]

Tahun Akademik/ Academic Year :

BAHAGIAN / SECTION A

BUTIR-BUTIR PERIBADI / PERSONAL DETAILS

1. Nama Penuh / Full Name :

Gelaran / Title:

(Awg/Dyg/Mr./Mdm/Mrs./Ms)

2. Bil. Kad Pengenalan /

Identity Card No. :

Y – Kuning / Yellow

P – Ungu / Purple

Warna / Colour :

G – Hijau / Green

O – Lain-Lain / Others

3. Bangsa/ Race

4. Ugama/ Religion

5. Jantina/ Sex

6. Taraf Kelamin/ Marital Status

M = Lelaki/ Male

F = Perempuan/ Female

SI = Bujang/ Single

MA = Kahwin/ Married

OT = Lain-Lain/ Others

8. Kerakyatan / Citizenship :

9. No. Sijil Kerakyatan (Jika berkenaan/

Citizenship Certificate No. (if applicable)

7. Bil. Pasport / Passport No. :

Tarikh Dikeluarkan / Date Of Issue:

Tarikh Mansuh / Date Of Expiry :

Tempat Dikeluarkan / Place of Issue: ________________________

10. Tarikh Lahir / Date Of Birth :

Tempat dan Negeri dilahirkan /

Place and Country of Birth :

* Sila tandakan/ Please indicate

-1-


Universiti brunei darussalam application form

11. Alamat Persuratan / Correspondence Address: 12. Alamat Tetap Pemohon / Applicant’s Permanent Address :

Kod Pos / Post -Code :

Telefon / Telephone :

Telefon Bimbit / Mobile Telephone:

Kod Pos / Post -Code :

Telefon / Telephone :

-

-

-

-

Faks / Fax :

-

Alamat E-Mail / E-Mail Address :

13. Orang Mudah Dihubungi/Saudara Terdekat (Nama & Alamat)Hubungan / Relationship

Contact Person / Next of Kin (Name & Address)

Nama / Name :

Rumah/ Home :

FA = Bapa / Father

MO = Ibu / Mother

GU = Penjaga / Guardian

HU = Suami/ Husband

WF = Isteri / Wife

OT = Lain-lain / Others

Telefon Rumah

Home Tel. No.

Telefon Pejabat

Office Tel. No.

Telefon Bimbit/Mobile Telephone :

Faks/ Fax

Pejabat /Office:

Kod Pos / Post-Code :

Perkerjaan / Occupation :

Alamat E-Mail/E-Mail Address :

14. Sila tandakanSumber Biayaan/ Please indicateSource of Funding

AS = Memohon biasiswa Kerajaan Brunei bagi pemohon negara-negara ASEAN/

Applying For Brunei Government Scholarship for ASEAN Country Applicant

TF = Universiti Brunei Darussalam Totalfinaelf Scholarship (Ph. D programme in Petroleum Geoscience only)

IW = Cuti Tidak Bergaji Dalam Negeri/ In-Service-Study Leave Without Pay

PC = Syarikat Swasta/ Private Company

PS = Sekolah Swasta/ Private School

PO = Pertubuhan Swasta Yang Lain/ Other Private Organisation

SS = Biayaan Persendirian/ Private Student (Self-Sponsored)

OT = Lain-Lain/ Others

Jika Syarikat/ Sekolah/ Organisasi/ swasta atau lain, sila nyatakan namanya :

If a private company/school/organisation or others, please state its name :

Alamat/ Address :

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Universiti brunei darussalam application form

15a. Nyatakan sama ada pernah menerima biasiswa kerajaan Negara Brunei Darussalam

State if you have ever been awarded Government of Brunei Darussalam Scholarship

Y = Ya/ Yes

N = Tidak/ No

Jika ada, nyatakan/ If yes, please state

Tempoh Kursus

Duration

Keputusan

Result

Nama Program

Name of Programme

Nama Institusi dan Negeri

Name of Institution and Country

Lulus/ Gagal

Pass/Fail

Dari Hingga

From To

[Sila sertakan salinan surat dari Kementerian /jabatan/ agensi berkenaan jika awda pernah ditamatkan penganugerahan biasiswa kerajaan Negara Brunei Darussalam.

15b. Adakah awda juga memohon Biasiswa Kerajaan Brunei Darussalam untuk melanjutkan pelajaran ke luar negeri pada tahun ini?

Have you also applied for government scholarship for overseas study this year?

Jika ada, nyatakan. / If yes, please state.

(i) Tarikh Permohonan : (ii) Nama Program :

Date of application : Name of Programme :

(iii) Nama Institusi (iv) Negeri :

Name of Institution :Country :

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Universiti brunei darussalam application form

BAHAGIAN / SECTION B

KELULUSAN-KELULUSAN AKADEMIK (Sijil Tinggi Kebangsaan / Diploma / Ijazah Pertama/ Ijazah Sarjana)

ACADEMIC QUALIFICATIONS (Higher National Certificate / Diploma / First Degree/ Masters Degree)

Tempoh Kursus (Tahun)

Duration (Year)

Kelulusan

Qualifications

Nama Institusi, negeri

Institution Name, Country

Kelas/Gred/Lulus/Gagal

Class/Grade/Pass/Fail

Bahasa Pengantar

Medium of Language

Dari

From

Hingga

To

BAHAGIAN/SECTION C

[untuk diisi oleh pemohon praperkhidmatan sahaja/is to be filled in by pre-service applicant only]

Jika baru menamatkan pengajian sila nyatakan :

If you have just completed your study please state :

Nama Sekolah/Maktab/Institusi :

Name of School/College/Institution :

Tahun menamatkan pengajian :

Year of Completing your study :

[Sila sertakan salinan sijil peringkat biasa dan lanjutan/Please attach copies of ‘O’ and ‘A’ level certificates]

BAHAGIAN / SECTION D

KEMAHIRAN BAHASA/LANGUAGE PROFICIENCY

Bahasa

Language

Menulis

Written

Membaca

Reading

Percakapan

Spoken

Melayu / Malay

Inggeris / English

Arab / Arabic

3 = Sangat Baik / Excellent

2 = Baik / Good

1 = Sederhana / Fair

Jika Lain, Sila Nyatakan

If others , Please State :

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Universiti brunei darussalam application form

BAHAGIAN/SECTION E

KEGIATAN LUAR DAN KEAHLIAN DALAM PERSATUAN/

EXTRA-CURRICULUM ACTIVITIES AND MEMBERSHIP IN ASSOCIATION

1. Sila nyatakan kegemaran/aktiviti sukan, kebudayaan, kesenian atau khidmat masyarakat

Please list any hobbies, sports, cultural activities or community services

2. Keahlian dalam Persatuan dan Badan-badan Ikhtisas/Membership of Associations and Professional Bodies

Tahun

Year

Nama Persatuan/Badan

Name of Association/body

Jawatan dipegang

Position held

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Universiti brunei darussalam application form

(Bahagian E dan F untuk diisikan oleh pemohon yang sedang bekerja sahaja

Section E and F are to be filled in by working applicant only)

BAHAGIAN/SECTION F

PEKERJA SEKARANG/PRESENT OCCUPATION

1. Jawatan Sekarang/Present Post

2. Tempat Bertugas/Place of Work

3. Nama dan Alamat Majikan/Employer’s Name and Address

4. Terangkan hubungkait Program yang dipohonkan dengan tugas awda

Indicate the relevance of the programme(s) applied for to your current duties

BAHAGIAN/SECTION G

PENGALAMAN KERJA YANG LALU/PAST WORK EXPERIENCE

Tarikh/

Dates

Nama dan alamat majikan/

Employer’s Name and Address

Jawatan/

Post

Dari/

From

Hingga/

To

-6-


Universiti brunei darussalam application form

BAHAGIAN/SECTION H

AM/GENERAL

Sila nyatakan sebab-sebab memohon/terangkan hubungkait tugas awda dengan program yang dipohonkan

State the reasons for your application/Explain the relationship between your job and the programme(s) applied

BAHAGIAN/SECTION I

PENYELIDIKAN DAN PENERBITAN

RESEARCH AND PUBLICATIONS

1. Sila senaraikan penyelidikan yang telah selesai dan penerbitan, jika ada

Please list completed research and publications, if any

2. Sila nyatakan bidang pengajian yang dicadangkan/Please indicate proposed field of study :

3. Tajuk Penyelidikan/Research Topic :

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Universiti brunei darussalam application form

4. Sila berikan sinopsis cadangan penyelidikan awda. (Sila kembarkan lampiran tambahan jika perlu)

Please provide an initial synopis of your research proposal. (Please attach additional sheet if necessary)

-8-


Universiti brunei darussalam application form

BAHAGIAN / SECTION J

NAMA ORANG YANG BOLEH DIRUJUK/ NAME OF REFEREES

1. Sila berikan dua nama dan alamat orang yang boleh dirujuk untuk mendapatkan laporan akademik.

Give the names and address of two referees to whom reference may be made on your academic record.

(i) Nama / Name :

Jawatan/Post :

Alamat / Address :

Telefon/ Tel :

Fax :

E-Mail :

(ii) Nama / Name :

Jawatan/ Post :

Alamat / Address :

Telefon/ Tel :

Fax :

E-Mail :

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Universiti brunei darussalam application form

BAHAGIAN / SECTION K

PENGAKUAN /DECLARATION

1. Bahawa dengan sesungguhnya saya mengaku semua maklumat yang diberikan adalah betul dan benar. Saya bersetuju

akan memaklumkan kepada pihak Universiti Brunei Darussalam sekiranya ada perubahan semasa pengajian saya di

Universiti Brunei Darussalam. Saya juga mengaku bahawa Unversiti Brunei Darussalam berhak untuk mengubah atau

menarik balik sebarang keputusan mengenai kemasukan saya ke Universiti Brunei Darussalam jika maklumat yang

diberikan adalah tidak tidak betul dan tidak benar.

I hereby certify that all the information provided by me is correct and true. I agree to inform Universiti Brunei

Darussalam if there is any change while I am studying at Univerisiti Brunei Darussalam. I aslo certify that Universiti

Brunei Darussalam reserves the right to vary or reverse any decision pertaining to my admission to Universiti Brunei

Darussalam if the information given is incorrect and untrue.

Tarikh / Date Tandatangan Pemohon/Applicant’s Signature

2. Pengesahan oleh Pengetua / Guru Besar Sekolah atau Pegawai Kementerian atau Ketua Jabatan atau Pengurus Syarikat :

Certification by School Principal / Head Master or Ministry Official or Head of Department or Company Manager :

Saya mengesahkan maklumat yang diberikan oleh pemohon pada pengetahuan saya adalah betul dan benar.

I certify that the information given by the applicant to the best of my knowledge is correct and true.

Nama /Name : Jawatan / Post:

Alamat Pejabat / Office Address :

Telefon / Telephone :

Tarikh / Date : Tandatangan / Signature :

Official Stamp

Alamat E-Mail/E-Mail Address :

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Universiti brunei darussalam application form

BAHAGIAN INI UNTUK DIISIKAN OLEH FAKULTI/ INSTITUT

THIS SECTION IS TO BE FILLED IN BY FACULTY/ INSTITUTE

Nama Permohonan :

Applicant’s Name :

Program Dipohonkan :

Programme Applied for :

Keputusan Permohonan :

Application Result :

Layak untuk ditemuduga

Qualified for an interview

Simpanan

Reserve

Ditolak

Rejected

Layak menduduki ujian bertulis

Qualified for sitting a written test

Sebab-sebab ditolak/ Reasons for being rejected :

Nama Penilai/ Assessor’s Name :

Tandatangan/ Signature :

Tarikh/ Date :

Keputusan Selepas Temuduga/ Ujian Bertulis/ Result After the Interview/ Written Test

Ditawarkan/ Offered

Ditolak/ Rejected

Sebab-sebab ditolak/ Reasons for being rejected :

Nama Penyelaras Panel Temuduga/ Ujian Bertulis/ Name of Coordinator of Interview/ Written Test Panel :

Tandatangan/ Signature :

Tarikh/ Date :

-11-


Universiti brunei darussalam application form

UNTUK KEGUNAAN UBD SAHAJA

Disemak oleh :

Tarikh :

Dimasukan dalam komputer oleh :

Tarikh :

Keputusan

Diterima

Simpanan

Ditolak

Tarikh :

Catatan :

STATUS PEMOHON

1. Program ditawarkan :

2. No Kad Pengenalan :

Warna :

3. Keputusan Peperiksaan Bahasa Melayu Peringkat Biasa :

Gred :

Tahun :

4. Status Ditawarkan :

i) Biasiswa Kerajaan

ii) Biayaan Persendirian

(Fee Paying)

Sebab-sebab Biayaan persendirian :

a) Bukan rakyat

b) Tidak mempunyai kelulusan Bahasa Melayu

c) Memohon untuk membiayai sendiri pengajian di UBD

d) Pernah ditamatkan biasiswa sebelum ini.

e) Dibiayai oleh pihak swasta

Nama swasta :

f)

iii) Cuti Belajar Dalam Negeri (Study Leave)

iv) Cuti Tidak Bergaji Dalam Negeri

Catatan:

HJM/lela - 15th. November, 2001

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Universiti brunei darussalam application form

UNTU KEGUNAAN UBD SAHAJA

Nama Pemohon :

Applicant’s Name :

Program dipohonkan :

Programme Applied for :

Keputusan Pemohon

Application Result

Ditawarkan

Offered

Simpanan

Reserve

Ditolak

Rejected

Sebab-sebab ditolak/ Reasons for being rejected :

Nama Penyelaras/ Pengerusi Jawatankuasa Penilai/ Name of Coordinator/ Chairman Assessment Committee :

Tandatangan/ Signature :

Tarikh/ Date :

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