Universiti Brunei Darussalam

Form GS -13

Graduate Admissions and Scholarship

Section A: Personal and contact information (All candidates are required to complete this
section)

Name in full:
(Mr/Mdm/Mrs/Ms)........................................................................................................................
Gender:. Date of Birth// Country of Birth:

Passport number:.. Country of issue:......

Date of issue: /.../.. Expiry date:/../.Citizenship:.

Contact telephone: Fax: Email address:..

Contact Address:.....
..
..

Section B: Acceptance of programme offer (All candidates are required to complete this
section)
Faculty/Academy: ...........................................................................(Example: Faculty of
Science)
Programme
offered: .........................................................................................................................................
(Example: PhD in Business Administration/Master in Sociology (by research)
Offer letter reference and date:.. Academic intake: January/August, Year...
...
I hereby ACCEPT / REJECT the graduate programme offered by Universiti Brunei
Darussalam.
(Please circle as appropriate.)

SECTION C: FOR CANDIDATES OFFERED WITH SCHOLARSHIP

Name of the scholarship offered:.

..
Name of the programme offered:
...
Offer letter reference and date:..... Academic intake: January/August, Year ..
..
I hereby ACCEPT / DECLINE the scholarship offer made by Universiti Brunei
Darussalam.
(Please circle as appropriate. Candidate must read attached Terms and Conditions of
Scholarship before signing below.)

I hereby certify all the information provided by me is correct and true, and agree that Universiti
Brunei Darussalam reserves the right to vary or reverse any decision pertaining to my admission
to Universiti Brunei Darussalam and scholarship (if offered), if the information given is incorrect
and untrue.

Signature:.
.
Name:

Date: