Office use only

YOUNG LEARNERS

Age in year of study : ____________________________Local School : Standard _______ Form _______International school : Year ___________________________

Total score /40 Recommended level:

Comments:

ADULTS

G: V: R: Overall: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.

Full time

_____________

Part time

_____________

Bus Eng PI

Bus Eng Int

Bus Eng UI

L IELTS

IELTS

Comments:

Name of advisor:PLEASE ENSURE THIS FORM IS RETURNED TO THE RECEPTION COUNTER.

Registration FormEnglish and Exams Services

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.

PERSONAL DETAILS MAKLUMAT PERIBADI)Title (Mr, Ms, etc): ___Mr______ Male √ Female (Gelaran)

Last name / Surname (as on NRIC /Passport):

_______Osman_____________________________

(Nama akhir/keluarga (seperti di No Kad Pengenalan / No Pasport)

First names(as on NRIC / passport):

__________Sazli__________________________

Nama awal (seperti di No Kad Pengenalan / No Pasport)

NRIC/Passport No: _____760827-07-5441_______________________________

(No Kad Pengenalan / No Pasport)

Date of Birth: date (DD)_27_month (MM) 08_year (YYYY_1976)

(Tarikh Lahir) (tarikh) (bulan) (tahun)

Nationality: __Malaysian_____ (Warganegara)

Address: Besi Apac Sdn. Bhd. (Alamat)

Jalan 26/7, Section 26, Shah Alam

Postcode:40000

( Poskod)

Country:Selangor, Malaysia

(Negara)

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/penjaga)

Tel No:- ___________________________________ (No Telefon)

Mobile No: ___________________________________

(No Telefon Bimbit)

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).

Student number

Test date:

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 012-5862913Bimbit)

Email Address ilzas_04@yahoo.com(Alamat Email)

NRIC / 760827-07-5441Pasport:

__________________________________________________

(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 Council’s 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 Kingdom’s 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 recordsBy signing this form, you agree to The British Council’s 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 tepatDengan 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 PolicyPolisi 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___________________

Registration form Nov 2013

Nov 2013