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PRIVATE & CONFIDENTIAL APPLICATION FORM All information in this form will be kept confidential and used solely for the purpose of completing the course application. 个人资料 PERSONAL DETAILS (USE BLOCK LETTERS) 1. 2. 4. 6. 8. Name in NRIC/passport 英文姓名 Name in Chinese 华文姓名 Country of Birth 出生国家 Date of Birth 出生日期 3. 5. 日 日 月 月 年 DDMMYY format NRIC/Passport No 身份证/护照号码 For international Students Only Type of Singapore Pass currently held, 10 Employment pass ‘S’ Pass Social Visit Pass N.A Country of Issue of Travel Province/State 12 Document 证件类型 RESIDENTIAL ADDRESS IN SINGAPORE Address 住址 州/省的出生 年 7. Nationality 国籍 Age 年龄 女 Please attach 2 recent passport size photographs 单身 已婚 婚姻状况 Single Married 11 Passport Date 发行日期 DDMMYY format 日 日 月 月 年 年 13 Issue 护照 Passport Expire Date 护照限期 请附上两张 个人近照 DDMMYY format 日 日 月 月 年 年 本地住址 15. 电邮 18. PERMANENT ADDRESS IN HOME COUNTRY 邮区 Mobile No. 手机号码 Tel. No. 电话号码 Postal Code 固定地址(For international Students only) 住址 20. Country 国家 22. Email 电邮 Fax 传 真 号 24. 码 NEXT OF KIN 近亲 (for emergency contact 紧急联系) 26. Name 姓名 27. 19. Male Female Marital Status 16. Email 男 性别 9. 14. 17. Gender Address 21. 23. 25. Relationship 邮区 Tel No. 电话号码 Mobile No. 手机号码 Postal Code 关系 28. + + Tel No. 电话号码 学历录,请附上相关文件(Please attached certified copies of qualification certificates and other official transcripts) 29. Highest Qualification Attained 最高学历 Name of school 学校名称 Qualification Awarded 资格授予 Country 国家 From (MM/YYYY) 从 To (MM/YYYY) 至 ACADEMIC BACKGROUND 30. EMPLOYMENT HISTORY Employer/ Company Name 雇主/ 公司名字 ADM-001 v8.3 工作经验 (Please attach separate sheet if space is insufficient Position Held 职位 Country 国家 Page 1 of 2 如果位置不足，请附加在白纸上) Period of Employment From (MM/YYYY) 工作年限从 Period of Employment To (MM/YYYY) 工作年限至 20130901 COURSE PREFERENCE 课程选项 31. 主修 32. Proposed Course & Major 3 3 . I would like to start the course 我想开始上课: Full Time 4 Year 201___ 3 . Part Time Month of ________________________ 35. From which source did you first learn about our instituition or programme that you are applying for? 你是从什么渠道了解我们的学校或你所申请的课程? [ ] Website 网站 [ ] Brochure 课程手册 展览 [ ] Exhibitions [ ] Friends / Relatives 朋友/亲属 代理 [ ] Agent/ EC [ ] Others: ____________________ Payment Methods Please do not pay any cash to PIC Agent/s or Staff. Student must pay the Application Fees of $500/- directly to Portman International College Pte Ltd UOB operational Account. The account information are as follows: For Application Fee of $500/-, please make payment through one of the following methods: Via telegraphic transfer, to be credited into Bank Name: United Oversea Bank Limited, Singapore Branch: Bukit Merah Branch Address: 80 Raffles Place UOB Plaza 1. Singapore 048624 Account Name: Portman International College Private Limited Account Number: 3933017573 Bank Code: 7375 Branch Code: 437 Swift Code: UOVBSGSG Or Via Cashier’s Order, Bank Draft or Cheque, kindly address it to Portman International College Private Limited Important Notice The above payment method is NOT meant for payment of MANDATORY FEES (Course Fees, Student Medical Insurance Fee, ICA Application Fee (for the 1st Application), Bank Transaction Fee for DBS Escrow Fee) These mandatory fees MUST be escrowed into Portman International College Pte Ltd Escrow Account. Invoice which will be issued when a student is accepted will state the payment methods for these mandatory fees. Parents and/or student may call our front office at 65-63762996 should there be any clarification needed for these different payment methods. 33. DECLARATION 声明 □ I declare that the information given in this application is accurate and complete. □ If my application is accepted, I agree to abide by the school’s regulations and to ensure prompt payment of fees for which I am liable. □ This application is not valid unless signed and dated. 我声明以上资料全部正确 声明以上资料全部正确. 以上资料全部正确. 一旦申请通过, 一旦申请通过,我将遵守校规以及保证定时缴付学费 我将遵守校规以及保证定时缴付学费. 校规以及保证定时缴付学费.这份申请书须要签名和写下日期才生效. 这份申请书须要签名和写下日期才生效. ------------------------------------------------------------------------------------------------Signature of applicant : 签名 -------------------------------------------------------------------------Date : (Parent/Guardian if applicant is below 18 years old) 日期 All information in this form will be kept confidential and used solely for the purpose of completing the course submission. 这本表格中的所有信息将保密， 本表格中的所有信息将保密，并只用于完成课程提交用途。 并只用于完成课程提交用途。 • • All accompanying documents must either be original documents or certified true copies of the original documents. If documents are not in English, notarized official translations must be included. Incomplete application form will not be processed. 请将表格寄还到 Please return to Portman International College Private Limited 168 Jalan Bukit Merah Connection One Tower 3 #04-07A/B Singapore 150168 Tel: 65-63762996 Fax: 65-62713147 Email: [email protected] ADM-001 v8.3 Page 2 of 2 20130901
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