FCERT 01/2018 This form has 2 pages

AIRWASTEWATER MANAGEMENT SDN BHD (779652-U) FOR OFFICE USE

(AWWAM) ONLY
Phone : +606-6013126
Fax : +606-6017127 Applicant No:
(Attn. : CSD 1; 011-53303881 (csd@awwam.com)
: CSD 2; 011-53303882
COURSE APPLICATION FORM
*AWWAM has the right to reject incomplete application.
1. Course Title 2. Course Date & Place
Course For Certified Environmental Professional In Scheduled Waste Date: 02 - 06 APR 2018 Page 1
---------------------------------------
Management (CePSWaM) Place: KOTA KINABALU
A. APPLICANT INFORMATION

3. Name Z W I N G L Y S U I N

4. IC No. 8 4 1 2 2 9 1 2 5 6 6 9 5. Age 3 4 years

6. Sex / Male Female
7. Nationality: / Malaysian / Others, please specify:

8. Bumiputera: / Bumiputra / Non-Bumiputra Others:

9. Mailing Address: P I T A S P A L M O I L M I L L

S D N B H D , L O T 5 & 6 , B L O C K
City 1 8 , M I L E 5 , P E N A M P A N G

Postcode 8 9 5 0 0 State K O T A K I N A B A L U

10. *Highest Qualification: SPM Polytechnic Certificate Diploma / Bachelor Master PhD
*Note: Min Qualification is SPM Certificate with 3 years of working experience (please submit certified true copy of the
Certificate & letter of support).

11. Field of Study: / Science; or Engineering Others Work Experiences: 1 3 years

12. Current Position: S T O R E K E E P E R

13. Contacts Tel No (O): 016-7160133 H/Phone: 014-3602407

Fax No (O): E-mail: xanxav1304@gmail.com

B. SPONSOR’S INFORMATION

Self-sponsored Company-sponsored / *To be filled in by company-sponsored only

If, company sponsored, do you need an invoice? YES / -----
NO
14. Name of Company / Employer:

PITAS PALM OIL MILL SDN BHD

15. Company Address for Invoicing Purposes:
LOT 5 7 6, BLOCK 18, BANDAR BARU PENAMPANG,
MILE 5, PENAMPANG ROAD,
89500 KOTA KINABALU,
SABAH.

16. Contacts Tel No (O): Fax No. (O):

088-718111

Person in charge : JOHN HIEW E-mail : johnhiew1119@hotmail.com

(Finance Department)
17. Type of Industry: (Tick one)

/ Manufacturing; Please specify PALM OIL MILLING

Mining & Quarrying; Please specify
Consulting; Please specify
Others: Specify
FCERT 01/2017 This form has 2 pages

Jacket Size: S (43 cm) M (45 cm) L (48 cm) XL (49 cm) / 2XL (50 cm) 3XL (53 cm) 4XL (58 cm)

*(Chest size in centimetre, cm)

I am a: / Non - vegetarian Vegetarian

C. PAYMENT INFORMATION
Page 2
18. Course Fee Amount: RM 3 9 7 5- 0 0 inclusive of GST.

19. Payment Method: Telegraphic Transfer (TT) : Money Order : Bank Draft :
Cheque : / Cheque No: R H B 0 0 0 3 6 2

* Payment by cheque / bank draft / postal order should be made payable to AIRWASTEWATER MANAGEMENT SDN
BHD (AC: 1052-4000-4868 ; Affin Islamic Bank Bhd) and received before or 14 days of the course registration.

Official Stamp of Organization:

Date: 0 5 0 3 2 0 1 8

Name & Signature of sponsor

Date: 0 5 0 3 2 0 1 8

Signature of applicant

TERMS & CONDITIONS

1. Fees are inclusive of course programme materials and refreshments.

2. Payment Terms: Following completion and return of the application form, full payment is required within seven (7) days from the receipt
of invoice.
PLEASE NOTE: Payment must be received prior to the confirmation of the course date. A receipt will be issued on payment. Due to
limited seats for the course participants, AWWAM advises early registration and payment to avoid disappointment.
3. Due to whatever reason, the course has to be cancelled or postponed; AWWAM is not responsible for covering airfare, hotel, or other
travel costs incurred by participants. The course fee will not be refunded, but can be credited to a future course within six (6) months. Course
programme contents are subject to change without prior notice.
4. Confirmation Details: After receiving payment, a receipt will be issued. If you have not received a letter of confirmation and the course
program within two (2) weeks prior to the event, please contact the course coordinator at AWWAM secretariat.
5. Attachments :
a. Please refer to course information in AWWAM brochure or website at www.awwam.com for entry requirements. If the desired
course has an entry requirements, please provide the indicated documents as attachment together with the form. All
attachments must be stamped with the words; CERTIFIED TRUE COPY.
b. Applications without the proper supporting documents will be rejected.
6. Payment Methods :
a. AWWAM accepts course fee payment made by cheque, bank draft, TT or Money Order. Payment should be made prior to
attending the course. The participant is not eligible to attend the course if the payment has not been made.
7. Completed application form may be sent to Airwastewater Management Sdn Bhd via facsimile (+606-6017127) or e-mail
(csd@awwam.com ).
8. Proof of postage is not proof of receipt. AWWAM will not be responsible for any documents lost in transit.

THANK YOU