KEMUDA INSTITUTE REGISTRATION FORM

Section 1 of 4

Section 1: Program Application

fields with * are required

Campus:
Study Mode:
Intake: March
June
September
Date:

23-11-17

Program:

Select Program

Course Options: (Choose your 1st and 2nd option)

Section 2: Personal Information

fields with * are required

*Full Name: *IC-Number
Gender: *DOB:
IC Color: Civil Status:
*Religion: *Place of Birth:
*Country of Birth: *Citizenship:
*Residential Address: *Contact Details



*Email Address: Medical Issues (if any):

Section 3: Qualification

Fields with * are required


Qualification: Year Subject Grade

Qualification:

Section 4: Parent/Guardian Details

Fields with * are required

Select:

*Full Name: *IC-Number:
*Address *Contact Details



Employer: *Job Title
Estimated monthly income (select one) $1,000 or less
B$1,001 – B$ 3,000
B$ 3,001 – B$ 5,000
B$ 5,001 or above
No Income

Submitting your application..


KEMUDA Institute Registration Form

BSB Branch

Unit 25, Ground Floor, Spg 633Jln Beribi,
Mukim Gadong Brunei Darussalam
Tel: +673-2655614/2448679

KB Branch

3rd Floor Sek.Tunas Jaya PGGMB Lot 6227,
Jln Pandan 6 Brunei Darrussalam
Tel: +673-3337761

Program Details

Registration Date:Text
Campus:
Study Mode:
Intake:
Program:
Course:

Personal Details

Full Name:
IC Number:
Gender:
Date of Birth:
IC Color:
Civil Status:
Religion:
Place of Birth:
Country of Birth:
Address:
Contact No:
Email Address:
Medical Issues:

Qualifications

Qualification Year Subject Grade

Guardian

Relationship:
Full-Name:
IC Number:
Address:
Contact Details:
Job Title:
Employer:
Estimated Income(Monthly):

Requirements to be attached

  • Photocopy IC (Front & Back) – 4 pieces Student & 1 Piece Parents
  • Photocopy Birth Certificate – Student 
  • 2 pieces Photocopy O level and/or A level Certificate or Other Relevant Qualifications
  • Photocopy of School Leaving Certificate
  • 3 pieces Passport-Sized Photo (Write your name & I.C. No. at the back)

RULES & REGULATIONS

  • Enrolling for a course at KEMUDA Institute (KI) constitutes a binding agreement on the student to follow the course schedule and to pay the full fee.
  • There will be no refund of fees once payment is made.
  • Minimum registration fee must be paid before a Student Confirmation Letter can be issued.
  • Students must comply with KI Attire regulations when entering classes. Attire regulation: Smart & Office Wear, please refer to www.kemudainstitute.com for further details.
  • Students who are late in starting their course will not be entitled for any refund, or reduction in course fees;this also applies where students have been absent from class for a period of time and where they may not have been attending all subjects for which they have enrolled. 
  • Important notices are displayed on KI main notice board or KI Facebook Page or KI Instagram and it is the student’s responsibility to ensure that such notices are read, understood and adhered.
  • All details printed in catalogue and/or accompanying documents are correct at the time of printing. KI reserves the right to make changes to the structure and content of courses, including the cancellation of classes, if deemed necessary.
  • Where an application form is signed on behalf of a student by his/her sponsor or guardian or representative, these conditions will still apply. 
  • Students must retain all receipts produced at the time of payment(s) made. Any claim or dispute without original receipts will not be considered.
  • The Principal reserve the right to require a student to leave a course at any stage if the student does not fulfill the above requirements, if a student’s continual presence would, in the opinion of the Principal, be detrimental to the wellbeing of staff, other students or KI generally or if a student does not meet his or her financial obligations.

STUDENT’S DECLARATION

I, hereby confirm that the information provided in this form is true and complete to the best of my knowledge. I have read, understand and agree to strictly adhere to all KEMUDA Institute’s Rules & Regulations.

Signature of Student:_______________________ Date:_______________________