FCP - FCP-Registration

KETERANGAN PEMOHON
APPLICANT'S DETAILS

Nama (seperti tertera dalam Pasport):*
Name (as appears in passport):

Please fill out this field.

Tarikh Lahir:*
Date of Birth:

Warganegara:*
Nationality:

Please fill out this field.

No. Kad Pengenalan:*
Identity Card No.:

Please fill out this field.

No.Pasport:*
Passport No.:

Please fill out this field.

Tarikh Mansuh Passport:*
Passport Date of Expiry:

Negara Pengeluar Pasport:*
Passport Issuing Country:

Please fill out this field.

Alamat E-mel:*
E-Mail Address:

Please fill out this field.

Alamat Rumah:*
Home Address:

Please fill out this field.

No. Telefon:*
Phone No.:

Please fill out this field.

Tarikh Mula Masuk / Keluar ke Negara Brunei Darussalam:*
Date of ENTRY / EXIT of Negara Brunei Darussalam:

MAKLUMAT TEMPAT BEKERJA / SEKOLAH / INSTITUSI PENGAJIAN
EMPLOYER / SCHOOL / EDUCATIONAL INSTITUTION'S DETAILS

Nama Jabatan / Kementerian / Syarikat / Sekolah / Institusi Penggajian:*
Name of Department / Ministry / Company / School / Employment Institution:

Please fill out this field.

Nama Fokal Agensi yang boleh dihubungi:*
Name of the Contactable Agency:

Please fill out this field.

No. Telefon:*
Phone No.:

Please fill out this field.

Alamat E-mel:*
E-mail Address:

Please fill out this field.

Sila pilih kategori:*
Please select your category:

Student / Pelajar
Employee / Pekerja

DOKUMEN-DOKUMEN SOKONGAN
SUPPORTING DOCUMENTS

Kad Pengenalan (depan dan blakang)
Identity Card (front and back):*

File Attachments

Dokumen Perjalanan - Passport (muka surat maklumat)
Travel Document - Passport (Detail's page):*

File Attachments

Dokumen Sokongan daripada majikan/sekolah/institusi pendidikan
Supporting document from employer/schools/educational institution:*

File Attachments

Maximum filesize not more than 2MB.
Files extension accepted: .jpg, .jpeg, .docx, .pdf, .png

PENGIKRARAN
DECLARATION

Semua keterangan yang saya berikan adalah betul dan jika didapati salah, saya boleh didakwa di bawah Bab 13, Akta Bayaran Keluar dan Bayaran Masuk (Penggal 232) dan jika sabit kesalah akan dikenakan denda tidak melebihi BND8,000, penjara tidak melebihi 1 tahun atau kedua-duanya sekali.
All information given is correct and if found incorrect, I will be charged under Section 13, Exit and Entry Charges Act (Chapter 232) and liable for conviction to a fine not exceeding BND8,000, imprisonment for a term not exceeding 1 year or both.