Series 4 2014 Private Candidate Entry Form Closing Date : 19 September 2014 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) Nationality
Date of Birth (dd/mm/yyyy)
Gender Male 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) nd Please circle on the correct Subject Code. For Double Diploma, please circle on the 2 diploma subject code column. Subject Code Subject Code Subject Name st nd (1 Diploma) (2 Diploma) 1 ASE1017 ASE1017 Book Keeping 1 ASE1041 ASE1041 English for Business (Reading & Writing) 2 ASE2007 ASE2007 Book Keeping & Accounts 2 ASE2041 ASE2041 English for Business (Reading & Writing) 2 ASE2025 ASE2025 Marketing 2 ASE2003 ASE2003 Business Calculations 2 ASE20071 ASE20071 Business Administration (New 2012) 2 ASE2407 ASE2407 Business Administration 2 ASE2009 ASE2009 Business Statistics 2 ASE20078 ASE20078 Text Production (New Syllabus) 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 3 ASE3030 ASE3030 Selling & Sales Management 3 ASE3025 ASE3025 Marketing 3 ASE3029 ASE3029 Public Relations 3 ASE20089 ASE20089 Advertising (2013) 3 ASE20074 ASE20074 Business Principles & Practice 3 ASE20072 ASE20072 Business Administration (New 2012) 3 ASE3407 ASE3407 Business Administration 3 ASE3041 ASE3041 English for Business (Reading & Writing) 3 ASE20079 ASE20079 Text Production (New Syllabus) Please make cheque payable to : LCCI INTERNATIONAL QUALIFICATIONS (M) SDN BHD Compulsory Administration Fees Level
Exam Fee (RM) 166.00 139.50 191.00 147.00 191.00 191.00 191.00 191.00 191.00 191.00 209.00 209.00 209.00 209.00 209.00 209.00 209.00 209.00 209.00 209.00 209.00 191.00 209.00 166.00 209.00
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) Level 2 Diploma in Book-keeping and Accounts – DIPBKACC2
Group Diploma in Marketing – DIPMAR07
Group Diploma in Accounting – DIPACC07
Group Diploma in Advertising – DIPADV07
Group Diploma in Management Accounting – DIPMANACC07
Group Diploma in Public Relations – DIPPUBREL07
Group Diploma in Cost Accounting – DIPCOSTACC07
Group Diploma in Selling & Sales Management – DIPSSM07
Others, please specify : ______________________________ OP-REG-F1 Page 1 of 2
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.
A photocopy of the National Identity Card Must be enclosed (COMPULSORY).
Please ensure that there will be a recipient (at the postal address) to acknowledge safe receipt for your result and certificate.
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)
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