8, Jalan Kerinchi, 59200, Kuala Lumpur, Malaysia. Tel: +603 2289 7000 Fax: +603 2289 7195 Email: operations.LCCI@pearson
September On-Demand Exam - Private Candidate Entry Form Closing Date : 15 August 2014 Personal Particulars (Please fill in BLOCK Letters) LCCI Centre code
CANDIDATE FULL NAME IN BLOCK LETTERS (as per National ID)
AMAL199A 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
City
State
Email Address
Home/Office No.
Mobile Phone No.
Preferred exam location (town)
Please circle on the Subject Code
Level
Subject Code st (1 Diploma)
Subject Code nd (2 Diploma)
3
ASE3012
ASE3012
Accounting
3
ASE3902
ASE3902
Accounting (IAS)
3
ASE3003
ASE3003
Advanced Business Calculations
3
ASE3009
ASE3009
Business Statistics
3
ASE3017
ASE3017
Cost Accounting
3
ASE3024
ASE3024
Management Accounting
Subject Name
Exam Date & Time 24 September 2014 (0900 – 1200) 24 September 2014 (0900 – 1200) 22 September 2014 (1400 – 1700) 22 September 2014 (0900 – 1200) 23 September 2014 (0900 – 1200) 23 September 2014 (1400 – 1700)
Exam Fee (RM) RM209.00 RM209.00 RM209.00 RM209.00 RM209.00 RM209.00
Please make cheque payable to : LCCI INTERNATIONAL QUALIFICATIONS (M) SDN BHD Compulsory Postage Fees
RM15.00
TOTAL FEES PAID Important: Please select the correct Group Diploma Awards. st nd Please indicate “1“ for your 1 Diploma; “2“ for your Double Diploma (2 Diploma)
DIPACC07
-
Group Diploma in Accounting
DIPCOSTACC07
-
Group Diploma in Cost Accounting
DIPMANACC07
-
Group Diploma in Management Accounting
LCCI International Qualifications (Malaysia) Sdn Bhd Level 1, Tower 2A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200, Kuala Lumpur, Malaysia Tel: +603 2289 7000 Fax: +603 2289 7195 Email:
[email protected] website: www.lcciasia.com OP-REG-F1
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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 of your results and certificates. 4. Please write the preferred state/town for the location of exam venue should the current address is different from your national ID. If the preferred state/town is not available in our list of exam venues, 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 at the period mentioned, please call LCCI Malaysia office for confirmation. 6. LCCI Malaysia reserves the right to cancel the exam if the exam cannot be held for any reason.
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.
*** Please include the compulsory RM15.00 Postage 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’s Signature
Date
For Office Use only Checked By
Data Entered
Receipt No
LCCI International Qualifications (Malaysia) Sdn Bhd Level 1, Tower 2A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200, Kuala Lumpur, Malaysia Tel: +603 2289 7000 Fax: +603 2289 7195 Email:
[email protected] website: www.lcciasia.com OP-REG-F1
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