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)

Female

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

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)
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 : ______________________________

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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 Bankers 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

Candidates 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 7199
Email: info.lcci.my@pearson.com
Website: www.lcciasia.com

OP-REG-F1

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