Academy/ACCA/FORM/290416/V4.2.1

UNITAR International Academy

3-01A, Level 3, Tierra Crest

Jalan SS6/3, Kelana Jaya

47301 Petaling Jaya, Selangor.

Tel: +603 7627 7200

Fax: +603 7627 7447

E-mail: academy@unitar.my

ACCA REGISTRATION FORM Please tick () where appropriate

I am a New Student Returning Student UNITAR ID

Please choose your study location: UNITAR Main Campus, Kelana Jaya UNITAR IRC Penang

UNITAR IRC Johor Bahru UNITAR IRC Kota Kinabalu UNITAR IRC Kuching

PART A: PERSONAL DETAILS

1. Full Name (as per NRIC/Passport):

2. Gender Male Female

3. NRIC No: - - 4. Date of Birth: D D M M Y Y Y Y

5. Nationality: Malaysian Others: Passport No:

6. Marital Status: Single Married Widowed Divorced

7. Ethnicity: Malay Chinese Indian Bumiputra Sabah Bumiputra Sarawak

Others:

8. Mailing Address & Contact Information

Postcode State Country

Mobile Phone No: Alternate Phone No:

Office Phone No: Home Phone No:

E-mail Address:

9. Education

Highest Qualification: Final CGPA / Standing:

University: Country:

10. Employment

Company Name: Designation:

11. Declaration of Fitness

Do you consider yourself to have a learning difficulty, disability or health problem? Yes No

If Yes, do you require any additional support? Yes, please specify: No

* Please provide sufficient information to enable us to provide you with the required level of support during your course of study.

PART B: NEXT OF KIN / CONTACT PERSON IN CASE OF EMERGENCY

1. Full Name:

2. Relationship to you:

3. Contact Information

Mobile Phone No: Alternate Phone No:

E-mail Address:

PART C: QUALIFICATION AND PROGRAMME DETAILS

1. Are you an ACCA registered student?

Yes, my ACCA registration no is:

No, I will register online before the stipulated deadline set by ACCA UK.

* It is your responsibility to register with the ACCA and enter the ACCA examinations.

2. Are you an active ACCA Member? Yes No

3. Are you a MIA Member? Yes No My MIA membership no is:

Academy/ACCA/FORM/290416/V4.2.1

4. Course Registration (Please tick () the appropriate paper and term option you intend to register for THIS PARTICULAR intake)

Paper1 Long Term:

Tuition & Revision Classes2

Intensive Revision

Classes Only5

Fundamental - Skills RM1,000.00 RM280.00

F4: Corporate and Business Law (MYS) January July ____________

F5: Performance Management January July ____________

F6: Taxation (MYS) January July ____________

F7: Financial Reporting (INT) January July ____________

F8: Audit and Assurance (INT) January July ____________

F9: Financial Management January July ____________

Professional – Essentials RM1,200.00 RM350.00

P1: Governance, Risk & Ethics January July ____________

P2: Corporate Reporting (INT) January July ____________

P3: Business Analysis January July ____________

Professional – Options (2 of 4) RM1,200.00 RM350.00

P4: Advanced Financial Management January July ____________

P5: Advanced Performance Management January July ____________

P6: Advanced Taxation (MYS) January July ____________

P7: Advanced Audit and Assurance (INT) January July ____________

Note: 1. Please check on papers offered at the specific study location and please ensure that there are no clashes before signing up for classes.

2. Long Term: January for the June exams; July for the December exams.

3. Intensive Revision Classes are conducted in February, May, August and November.

4. New students are subject to a one-time registration fee of RM150.00.

5. Fees are subject to change as may be determined by the Academy from time to time.

5. I would like to purchase Learning Materials as follows:

Description Price/paper Paper

BUNDLE Learning Materials: Kaplan Complete Text, Revision Kit & Study Notes, and Lecturer’s Notes RM140.00

Study Text: Kaplan Complete Text & Lecturer’s Notes RM100.00

Revision Kit: Kaplan Revision Kit Only RM 40.00

Lecturer’s Notes Only (including F6 (MYS) and P6 (MYS)) RM 20.00

*Kaplan Learning materials are not available for F6 (MYS) and P6 (MYS).

PART D: PAYMENT METHOD (Please refer to UNITAR Schedule of Fees for more information)

CASH CHEQUE Cheque No: (made payable to UNITAR International Academy Sdn Bhd)

BANK-IN / ONLINE TRANSFER Maybank Islamic Berhad Account No: 5623 5751 0184 (Account Name: UNITAR International Academy Sdn Bhd)

*Kindly attach the bank-in or online transfer slip together with this form as proof of payment.

CREDIT/DEBIT CARD Cardholder’s Name (as per on card):

Credit/Debit Card No: - - - Card Expiry: M M / Y Y

PART E: DECLARATION

I sincerely declare that:

i) I am of legal age, of sound mind and qualified to form a binding contract and not a person barred from

receiving services under the laws of Malaysia or other applicable jurisdiction.

ii) I agree to: (a) provide true, accurate, current and complete information about myself as prompted by this

registration form and (b) maintain and promptly update the registration data to keep it true, accurate,

current and complete. If any information I provide is untrue, inaccurate, not current or incomplete, or the

Academy has reasonable grounds to suspect that such information is untrue, inaccurate, not current or

incomplete, the Academy has the right to reject my application into the Academy or suspend or terminate

my enrolment as student of the Academy and refuse any and all current or future use of the service of the

Academy without prejudice to the Academy’s right accrued before such suspension or termination.

iii) I agree with UNITAR Personal Data Protection Act 2010 policy to collect my data.

iv) By signing this registration form, I acknowledge that I clearly understand all the terms of my enrolment with

UNITAR Academy, including but not limited to terms on refunds, deferments and waivers.

Signature

Name:

Date:

MyKAD No:

FOR OFFICE USE ONLY A. To be completed by Student Finance Services Department B. To be completed by UNITAR International Academy

The student has FULLY PAID the following fees:

Registration Fee .

Course Fee .

Learning Materials .

TOTAL .

Receipt No

Remarks:

Date:

Processed by:

The student’s form has been received for processing on D D M M Y Y

Received by:

Signature: _____________________________

Name: ________________________________

Remarks: