Series 3 2013 Private Candidate Entry Form Closing Date : 18 ...

Series 3 2013 Private Candidate Entry Form
Closing Date : 18 March 2013
Personal Particulars (Please fill in BLOCK Letters)
CANDIDATE FULL NAME IN BLOCK LETTERS (as per National ID)
LCCI Centre code
NRIC/Passport No.
(attach photocopy)
Date of Birth
(dd/mm/yyyy)
Nationality Gender Male Female
Do you have any physical disabilities that may affect you in the examination Yes/No (If yes please indicate)
Postal address (Please ensure someone is available to receive the certificates)
Postcode
State
Email Address
Home/Office No.
Mobile Phone No.
Preferred exam location (town)
Please circle on the correct Subject Code. For Double Diploma, please circle on the 2 nd diploma subject code column.
Level
Subject Code Subject Code
Exam Fee
(1 st Diploma) (2 nd Subject Name
Diploma)
(RM)
1 ASE1017 ASE1017 Book Keeping RM158.00
1 ASE1041 ASE1041 English for Business (Reading & Writing) RM133.00
2 ASE2007 ASE2007 Book Keeping & Accounts RM182.00
2 ASE2041 ASE2041 English for Business (Reading & Writing) RM140.00
2 ASE2025 ASE2025 Marketing RM182.00
2 ASE2003 ASE2003 Business Calculations RM182.00
2 ASE2407 ASE20071 Business Administration(New 2012) RM182.00
2 ASE2009 ASE2009 Business Statistics RM182.00
3 ASE3012 ASE3012 Accounting RM199.00
3 ASE3902 ASE3902 Accounting (IAS) RM199.00
3 ASE3003 ASE3003 Advanced Business Calculations RM199.00
3 ASE3009 ASE3009 Business Statistics RM199.00
3 ASE3017 ASE3017 Cost Accounting RM199.00
3 ASE3024 ASE3024 Management Accounting RM199.00
3 ASE3030 ASE3030 Selling & Sales Management RM199.00
3 ASE3025 ASE3025 Marketing RM199.00
3 ASE3029 ASE3029 Public Relations RM199.00
3 ASE3002 ASE3002 Advertising RM199.00
3 ASE20074 ASE20074 Business Principles & Practice RM199.00
3 ASE3407 ASE20072 Business Administration(New 2012) RM199.00
3 ASE3041 ASE3041 English for Business (Reading & Writing) RM158.00
Please make cheque payable to :
LCCI INTERNATIONAL QUALIFICATIONS (M) SDN BHD
Compulsory Adminstration Fees RM15.00
Important: Please select the correct Group Diploma Awards.
Please indicate “ 1 “ for your 1 st Diploma; “ 2 “ for your Double Diploma (2 nd Diploma)
City
TOTAL FEES PAID
Level 2 Diploma in Book-keeping and Accounts – DIPBKACC2
Group Diploma in Accounting – DIPACC07
Group Diploma in Management Accounting – DIPMANACC07
Group Diploma in Cost Accounting – DIPCOSTACC07
Group Diploma in Marketing – DIPMAR07
Group Diploma in Advertising – DIPADV07
Group Diploma in Public Relations – DIPPUBREL07
Group Diploma in Selling & Sales Management – DIPSSM07
Others, please specify
OP-REG-F1
LCCI International Qualifications (Malaysia) Sdn Bhd
Pearson Malaysia Sdn Bhd (4409W)
Level 1, Tower 2A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200 K. Lumpur, Malaysia
Tel: +603 2289 7000 Fax: +603 2289 7195 Email: operations.LCCI@pearson.com Website: www.lcciasia.com
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IMPORTANT NOTE
1. Please ensure that the correct subject code is circled as No amendment will be allowed after the
Exam Entry Form has been submitted to LCCI Malaysia office.
2. A photocopy of the National Identity Card Must be enclosed (COMPULSORY).
3. Please ensure that there will be a recipient (at the postal address) to acknowledge safe receipt
for your result and certificate.
4. Please write the preferred state/town for the location of exam venue. If the preferred state/town
is not available, we will allocate to the next nearest state/town.
(Note : Any changes after submission is Not allowed)
5. Examination Docket will be mailed to the address provided in the Exam Entry Form approximately
two weeks before the start of the examination. If you do not receive your exam docket by then,
please call to LCCI Malaysia office.
Payment Mode: ( Please tick √ )
□
Bank Draft or Banker’s Cheque payable to LCCI INTERNATIONAL QUALIFICATIONS (MALAYSIA)
SDN BHD
□ Direct Bank-in to LCCI Bank Account No: HSBC 359-131224-101
** For Direct Bank-in to HSBC account, please submit the copy of “Bank-in Slip” together with your exam
Registration form
Please write clearly your Name and National ID Number on the copy of the “Bank-in Slip” for payment
tracking
Registration form sent without attachment of payment proof of “Bank-in Slip” will Not be accepted.
*** NOTE: Please include the compulsory RM15.00 Administration Fee together with Examination fees.
*** All fees paid ARE NOT REFUNDABLE
Candidate’s Declaration
I declare that the above information is correct and note that related information may be used for employment
and marketing purposes
Candidate Signature & Date:
For Office Use only
Checked
By
Data
Entered
Receipt No
LCCI International Qualifications (Malaysia) Sdn Bhd
Pearson Malaysia Sdn Bhd (4409W)
Level 1, Tower 2A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200 K. Lumpur, Malaysia
Tel: +603 2289 7000 Fax: +603 2289 7195 Email: operations.LCCI@pearson.com Website: www.lcciasia.com
OP-REG-F1
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