BRUNERF

B.Melayu BORANG PENDAFTARAN

BRUNERF: BATTLE 4 Vs. 4 FIGHT OF THE FLAGS (FOTF)
Sempena Festival Cheo’ Cheo’ Le Long Belait anjuran Jabatan Daerah Belait

NAMA KUMPULAN: _____________________________________________ (Max. 15 huruf)

*Nama pemain sila tulis dengan lengkap dan huruf besar
Pemain 1 (Kapten):
Pemain 2:
Pemain 3:
Pemain 4(Medik):

Bagi kumpulan yang mempunyai pemain berusia di bawah 18 tahun, sila dapatkan kebenaran
daripada ibu/bapa atau penjaga terlebih dahulu dan isikan bahagian ini.
Nama Ibu/Bapa/Penjaga:
No. Kad Pengenalan: Pertalian/kaitan:
No. Telefon (yang mudah dihubungi)
Tanda tangan Ibu/Bapa/Penjaga:

Sila baca dan fahamkan peraturan-peraturan yang terdapat di nota sebelah

PENGAKUAN:
“SAYA TELAH MEMBACA DAN MEMAHAMI APA YANG DINYATAKAN PADA PERATURAN DAN SYARAT
YANG DINYATAKAN. SAYA SELAKU WAKIL KUMPULAN SAYA BERSETUJU DENGAN SEGALA SYARAT
PERTANDINGAN DAN AKAN BERTANDING DENGAN BAYARAN B$15”

Nama Kapten: No. Kad pengenalan:

No. Mobile (untuk dihubungi):
No. telefon lain:
Tanda tangan: Tarikh bayaran:

HAD LIMIT KUMPULAN YANG TURUT SERTA IALAH 32 KUMPULAN SAHAJA. KUMPULAN YANG
MENGHANTAR BORANG PENDAFTARAN DAN MEMBAYAR LENGKAP LEBIH AWAL ADALAH
DIUTAMAKAN
Sila dapatkan dan hantarkan borang pendaftaran ini kepada bahagian pendaftaran pertandingan:
1. BRUNERF (Bandar) - AK HASRA HILMI [8855558]
2. BRUNERF (Tutong) - MD. NAJIB IZZUDDIN ABD. SAMAD [7145712]
3. BELAIT NERFERS - HJ. MD. GHAZALI HJ. JA'AFAR [8887908]
4. BELAIT NERFERS - KHAIRIL MASHUD [8823099]
5. BELAIT NERFERS - JUSTINA BAHARUN [8884575]

Untuk diisi bahagian pendaftaran sahaja

Borang pendaftaran dan bayaran disahkan oleh:
Cawangan Brunei Muara Nama:
Cawangan Tutong
Cawangan Belait Tandatangan/Cop: Tarikh:
BRUNERF

English REGISTRATION FORM FOR

BRUNERF: BATTLE 4 Vs. 4, FIGHT OF THE FLAGS (FOTF)
For the Cheo’ Cheo’ Le Long Belait festival
TEAM’S NAME: _____________________________________________ (Max. 15 letters)
*Please write down the players’ names in capital letters
Player 1 (Captain):
Player 2:
Player 3:
Player 4(Medic):

For team members who is under the age of 18 years old, please ask for parents’/guardians’
permission and fill in the details below.
Parent’s/guardian’s name:
I.C number: Relationship:
Contact no.
Parent’s/guardian’s signature:

Please read and understand the rules printed

ACKNOWLEDGEMENT:
“I HAVE READ AND UNDERSTAND WHAT THE RULE IS OTHERWISE STATED. ON BEHALF OF MY TEAM I
AGREE WITH THE REPRESENTATIVE OF THE COMPETITION RULES, TERMS AND CONDITIONS OF THE
GAME AND WILL PARTICIPATE WITH B$ 15 FEE”

Captain’s name: I.C no:

Contact number:
Alternative contact number (optional):
Signature: Date of payment:

THE NUMBER OF TEAMS LIMITED TO PARTICIPATE IS 32 TEAMS. THEREFORE THE TEAMS THAT
SUCCESFULLY COMPLETED, HANDED OVER AND PAID THE FULL PAYMENT FOR THE REGISTRATION
FIRST ARE PRIORITISED.
Please get and submit the registration forms from the registrars mentioned below:
1. BRUNERF (Bandar) - AK HASRA HILMI [8855558]
2. BRUNERF (Tutong) - MD. NAJIB IZZUDDIN ABD. SAMAD [7145712]
3. BELAIT NERFERS - HJ. MD. GHAZALI HJ. JA'AFAR [8887908]
4. BELAIT NERFERS - KHAIRIL MASHUD [8823099]
5. BELAIT NERFERS - JUSTINA BAHARUN [8884575]

To be completed by the registrar upon receiving the complete returned form and full payment
Registration forms and payments approved by:
Brunei Muara branch Name:
Tutong branch
Belait branch Signature/Stamp: Date: