PSMB Gig 1 20 - Trainee Registration Form
PSMB Gig 1 20 - Trainee Registration Form
PSMB Gig 1 20 - Trainee Registration Form
A. TRAINING INFORMATION
1 Course Title :
……………………………………………………………………….........…………….....
……………………………………………………………………….........…………….....
……………………………………………………………………….........…………….....
2 Training Delivery : Classroom Virtual Blended Others :
Please specify……………………
3 Total Duration :
Days Hours
4 Start Date :
……………………………………………………………………….........…………….....
5 Completion Date :
……………………………………………………………………….........…………….....
6 Venue :
……………………………………………………………………….........…………….....
……………………………………………………………………….........…………….....
7 Mode of Training :
Full Time Part-Time
8 Training Provider :
……………………………………………………………………….........…………….....
B. TRAINEE INFORMATION
1 Name :
……………………………………………………………………….........…………….....
……………………………………………………………………….........…………….....
2 NRIC No. :
……………………………………………………………………….........…………….....
3 Gender :
Male Female
4 Race : Malay Chinese Indian Others :
Please specify……………………
5 Address :
……………………………………………………………………….........…………….....
……………………………………………………………………….........…………….....
……………………………………………………………………….........…………….....
1
6 Tel. No :
……………………………………………………………………….........…………….....
7 Email :
……………………………………………………………………….........…………….....
04 Diploma
05 Bachelor Degree
06 Master Degree
07 Doctoral Degree
I declare that the facts stated in this application and the accompanying information are true and correct
and that I have not withheld / distorted any material facts. I understand that if I obtain the grant by
false or misleading statements, I may be prosecuted.
Signature :
…………………………………………………………
Name :
…………………………………………………………
NRIC No. :
…………………………………………………………
Date :
…………………………………………………………