PLEASE ENSURE THIS FORM IS RETURNED TO THE RECEPTION

COUNTER.

Office use only

Student
number

Registration Form
English and Exams Services

Test date:

YOUNG LEARNERS
Welcome to the British Council, Kuala Lumpur. Kindly complete this
form and return it to us.
Selamat datang ke British Council, Kuala Lumpur. Sila lengkapkan
borang ini dan kembalikan kepada kami.

Age in year of study : ____________________________

Local School
: Standard _______ Form _______
International school : Year ___________________________

/40 Recommended level:

Total score

PERSONAL DETAILS MAKLUMAT PERIBADI)

Title (Mr, Ms, etc):
___Mr______
Male
(Gelaran)

Female

Last name / Surname

_______Osman_____________________________
(as on NRIC /Passport):
(Nama akhir/keluarga (seperti di No Kad Pengenalan / No Pasport)

Comments:

First names
__________Sazli__________________________
(as on NRIC / passport):
Nama awal (seperti di No Kad Pengenalan / No Pasport)

ADULTS
G:
Overall:

V:

NRIC/Passport No:

R:

(No Kad Pengenalan / No Pasport)

Recommended Level

1. Write the level for

full-time or part-time.
Write both if student
is unsure which they
will study.
2. Circle an arrow to
indicate if student
may be placed one
level higher, lower or
no other level.

_____760827-075441_______________________________

Full time

_____________

Part time

_____________

Date of Birth:

date (DD)_27_month (MM) 08_year (YYYY_1976)

Bus Eng PI

(Tarikh Lahir)

(tarikh)

Bus Eng Int

Nationality:
(Warganegara
)

__Malaysian_____

Bus Eng UI

L IELTS

IELTS

Comments:

Address:
(Alamat)

Postcode:
( Poskod)
Country:
(Negara)

(bulan)

(tahun)

Besi Apac Sdn. Bhd.

Jalan 26/7, Section 26, Shah Alam
40000
Selangor, Malaysia

If you are below 18 please provide the contact details of your parent/guardian

(Jika anda berumur bawah 18 tahun sila isikan maklumat perhubungan ibubapa/penjag

Name of advisor:

Tel No:(No Telefon)

Mobile No:

___________________________________
___________________________________

The British Council is the United Kingdom's international organisation for cultural relations and educational opportunities.
British Council Malaysia is a branch (995232-A) of the British Council, registered as a charity in England and Wales (209131) and Scotland (SC037733).

(No Telefon Bimbit)

Email address:
( Alamat E-mel)

___________________________________

Please let us know about any special requirements you/your child has in terms of
health, allergies, physical (e.g. hearing impaired) or special learning needs (e.g.
dyslexia, ADD). (Sila maklumkan kami tentang sebarang keperluan khas yang
anda/ anak anda ada dari segi kesihatan, alahan, fizikal (contohnya kurang
pendengaran) atau keperluan pembelajaran khas)
___________________________________________________________

PARENT/ GUARDIAN DETAILS if student is below 18 (Maklumat

Ibubapa/Penjaga jika pelajar berumur bawah 18 tahun)
Full name:
_____________________________________________________
(Nama Penuh seperti di dalam kad pengenalan)
Telephone No:
(No Telefon)

__________________________________________________

Mobile No
(Telefon 0125862913Bimbit)
Email Address
ilzas_04@yahoo
.com
(Alamat Email)
NRIC / 760827075441Pasport:
(No Kad Pengenalan / No Passpot)
I hereby give my consent for the care and treatment of my child in the case of
accident or medical emergency. (Saya mengizinkan anak saya menerima jagaan dan
rawatan sekiranya berlaku kemalangan atau kecemasan perubatan)
Please note that the British Council does not take liability for the outcome of
any medical treatment given to your child by a qualified medical
practitioner. (Dimaklumkan bahawa British Council tidak bertanggungjawab ke atas
akibat rawatan perubatan yang diberi kepada anak kamu oleh seseorang ahli
perubatan yang diiktiraf.)
Signature (Tandatangan): ____________________________________________

Stay up to date with The British Councils new events, exhibitions, products and
services. If you wish to receive any of this information, please tick the relevant
boxes. Sila tandakan di sini jika anda berminat untuk mengikuti perkembangan
terkini daripada British Council seperti akitiviti, pameran, produk and
perkhidmatan .

Email

SMS

Newsletter

The British Council Data Protection Notice /

Notis Perlindungan Data British Council
Under the terms of the United Kingdoms Data Protection Act, 1998, the British
Council is required by law to manage any personal information you give to us about
yourself or your child securely and only for the purposes we have specified.

To maintain academic and educational records on our students

To provide academic records for our students sponsors, where applicable

To be able to cater for any special needs our students

To maintain an accurate database on our students for communication purposes

To maintain accurate financial records

By signing this form, you agree to The British Councils collecting and processing this
information for the purposes specified above, which may involve the transfer of your
data to another British Council office.
Di bawah syarat-syarat Akta Perlindungan Data United Kingdom, 1998, The British
Council perlu menguruskan sebarang maklumat peribadi yang anda berikan
mengenai diri anda atau anak anda dengan cara yang selamat dan hanya untuk
tujuan yang kami nyatakan sahaja.

Untuk menyimpan rekod akademik dan pendidikan para pelajar kami

Untuk memberikan rekod akademik kepada penaja pelajar, bila perlu

Untuk bersedia memenuhi sebarang keperluan khas para pelajar

Untuk mengekalkan pengkalan data berkenaan para pelajar kami yang tepat bagi
tujuan komunikasi

Untuk menyimpan rekod kewangan yang tepat

Dengan menandatangani borang ini, anda bersetuju bahawa The British Council
boleh mengumpul dan memproses maklumat ini bagi tujuan-tujuan yang
disenaraikan di atas, di mana ia mungkin melibatkan pemindahan data anda ke
pejabat British Council yang lain.
British Council Child Protection Policy

Polisi Perlindungan Kanak Kanak British Council

The British Council is committed to a policy of child protection. A copy of our
global policy is on display in all our centre. The Child Protection Policy covers all
children under the age of 18.
(British Council komited kepada dasar perlindungan kanak-kanak. Salinan polisi global
kami dipamerkan di pejabat kami. Polisi Perlindungan Kanak-kanak meliputi semua
kanak-kanak di bawah umur 18 tahun)
I have read and I understand the British Council Data Protection Notice and
the British Council Child Protection Policy. (Saya telah membaca dan memahami
Notis Perlindungan Data British Counci dan Polisi Perlindungan Kanak Kanak British
Council.)

Signature (Tandatangan): __________________________Sazli

Osman___________________
Nov 2013

Registration form Nov 2013