Section A: Personal and contact information (All candidates are required to complete this section)

Name in full: (Mr/Mdm/Mrs/Ms)........................................................................................................................

Gender:…………………. Date of Birth………/………/…………… Country of Birth:……………………………

Passport number:…………………………………..… Country of issue:…………………….….……..……..……

Date of issue:……… /…….../…..…… Expiry date:………/…..……/……….Citizenship:………………….……

Contact telephone:……………………… Fax:…………………… Email address:…………………………..……

Contact Address:….………………………………………………………………………….…………………..…….

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Section B: Acceptance of programme offer (All candidates are required to complete this section)

Faculty/Academy: ……………...........................................................................(Example: Faculty of Science)

Programme offered: ......................................................................................................................................... (Example: PhD in Business Administration/Master in Sociology (by research)

Offer letter reference and date:.………………….… Academic intake: January/August, Year….…..………... I hereby ACCEPT / REJECT the graduate programme offered by Universiti Brunei Darussalam. (Please circle as appropriate.)

SECTION C: FOR CANDIDATES OFFERED WITH SCHOLARSHIP

Name of the scholarship offered:…………………………………………………………………….………………..

Name of the programme offered:……………………………………………………………………………………...

Offer letter reference and date:.……………………….... Academic intake: January/August, Year …..………..

I hereby ACCEPT / DECLINE the scholarship offer made by Universiti Brunei Darussalam. (Please circle as appropriate. Candidate must read attached Terms and Conditions of Scholarship before signing below.)

Universiti Brunei Darussalam Form GS -13

Graduate Admissions and Scholarship

I hereby certify all the information provided by me is correct and true, and agree that Universiti Brunei Darussalam reserves the right to vary or reverse any decision pertaining to my admission to Universiti Brunei Darussalam and scholarship (if offered), if the information given is incorrect and untrue.

Signature:……………………………………………………………. Date:

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Name:…………………………………………………………………