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Registration Form
Registration Date : 24 May 2013
Register for : 1CITIZEN

Guideline


Guideline
Please refer to the following guidelines in order to complete this Online Application Form.
1 . All entries must be UNIQUE to the individual applicant and must not be used or by chance have been used by any other applicant with regard to the following items.
i . Identity Card No/Passport No
ii . Email Address
2 . Fields that are designated with asterisk (*) are mandatory for applicants to fill in.
Failure to include complete information with regard to the above items will impact your chance of securing enrolment to 1CITIZEN.
3 . Your username is automatically generated from your NRIC/Passport No.
Meanwhile, your password will be sent to your registered email account. You can change your password later. Therefore, you must enter your active email correctly.
 

Personal


Personal Details
 
Salutation :  
eg: Prof, Prof Madya, Dr, Ir, Datuk, Datin, Dato' or leave blank.
Do not enter for Encik, Cik, Mr, Mrs & Miss.
Name* :
 
First Middle (Bin, Binti, A/L, A/P ) Last  
Nationality* : Malaysian citizen     Non-citizen
NRIC* : - - eg: 872356-67-3456
This will be your username to login to the system.
Mobile No* :
Email Address* :  
  eg: joe@yahoo.com
Applicants are required to fill in the correct email address. Any news/update regarding this program will be sent to your email.
Race : Malay   Chinese   Indian   Bumiputra   Others  
Gender : Male    Female
Fields that are designated with asterisk (*) are mandatory for applicants to fill in.
 

Institution


Institution Details
 
Institution Category* :
Participant Type* : Student    Lecturer    Staff
Student ID* :
  eg: AF2356673456
Part / Semester  
Fields that are designated with asterisk (*) are mandatory for applicants to fill in.
 

Permanent Address


Permanent Address
 
Permanent Address* :
Street*
   
City* State* Postcode/Zipcode*
   
Country*
Contact No :
-   -  
Mobile No   Home No  
Fields that are designated with asterisk (*) are mandatory for applicants to fill in.
 

Correspondence Address


Correspondence Address
Same as Permanent Address.
Correspondence Address* :
Street*
   
City* State* Postcode/Zipcode*
   
Country*
Contact No :
-   -  
Mobile No   Home No  
Fields that are designated with asterisk (*) are mandatory for applicants to fill in.
 

Confidential


 

Confidential Document
You are required to sign this document because you receive IC CITIZEN learning and training materials under the IC CITIZEN Training and Certification Program. All participants, partners, training providers and staff ("Members") will be asked to sign this as well.

In the course of your participation in IC CITIZEN Training and Certification Program you may have access to confidential information relating to the business ideas, concepts and inventions of the other participants/contributors, such information may be written (in hard copy or electronic format) or spoken ('information'). In order for Members to freely take part in IC CITIZEN Training and Certification Program, it is vitally important that you respect and preserve the confidentiality of the Information made available to you. You therefore agree and undertake to us Prestariang Systems Sdn Bhd ("Prestariang Systems") and to your fellow Members as follows:

You confirm that as a condition of being allowed to participate in IC CITIZEN Training and Certification Program and in consideration of the disclosure of information by any of the Members in IC CITIZEN Training and Certification Program, you will keep confidential all information that you receive in the course of IC CITIZEN Training and Certification Program and will not divulge such information to any third party at any time and in any form whatsoever for any purpose other than your participation in IC CITIZEN Training and Certification Program, and you will not use the information for your own benefit or the benefit of any organisation of which you are affiliated with.

At the conclusion of IC CITIZEN Training and Certification Program, you will not copy or reproduce, in any form, information provided to you by Prestariang Systems. In addition, you will return, destroy or erase any information that you may have received or recorded in whatever format, should it required by Prestariang Systems.

These obligations shall not apply to any information which, you can show to our reasonable satisfaction:
  (a) is at the date of this letter is in the public domain or subsequently comes into the public domain through no guilt of yours and not in breach of these obligations

(b) was already known to you on the date of disclosure provided that such prior knowledge can be substantiated and proven by documentation

(c) properly and lawfully becomes available to you from sources independent of the disclosing participant

(d) is independently developed by you without access to the information received by you and where the independent development can be proven by contemporaneous written documentation

(e) you are required to disclose by a court of competent jurisdiction or statute.
These obligations will apply for the duration of IC CITIZEN Training and Certification Program and shall remain in effect for a period of five (5) years thereafter.
I, hereby understand and agree on the abovementioned terms.
  Name :  
  Date :   24 May 2013
       
 
 

Declaration


Declaration
 

Type the code you see in the image below:




*code characters are CASE-SENSITIVE.
I, hereby declare that the information contained herein is complete and accurance to the best of my knowledge. I fully understand that with holding or giving false information, Prestariang Systems Sdn. Bhd. has the right to reject or revoke my application or terminate my participation in 1CITIZEN program at any time.
 
 
 
 
 


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