ADMISSION FORM

FULL TIME STUDENTS

Instructions :

1. Please fill out this form clearly using BLOCK LETTERS.

2. Sign the application form and have the admission form signed by your parent/guardian/sponsor.
3. Enclose all supporting documents with this application as per the checklist.
4. An admission fee of IDR 3,500,000 must be paid upon submission of this form. (non-refundable)
5. It is your responsibility to advise the APCA Indonesia regarding any change of contact
details.
6. Please fill in the Accommodation Form if you require assistance with housing.

Please send / hand in your Admission Form to :

APCA Indonesia
Address: The Flavour Bliss, Unit FB2, No 19-20 Jl. Alam Sutera Boulevard, Pakulonan, Serpong Utara,
Tangetang Selatan, Banten, 15325 Indonesia.

E-mail: info@apcaindonesia.com

Payment Options :

Payment in CASH directly to the APCA Indonesia.

Payment by CHEQUE issued to PT. Lentera Sinergi Abadi.

Payment by BANK TRANSFER to:

Account of: PT. Lentera Sinergi Abadi.
Name of Bank: BCA
Account No: 6043939888

Type: PASTRY CULINARY

SECTION 1 PROGRAMME PREFERENCE

Intake date:

Please indicate your choice of programme below.

I am interested in the Full Time Program Advanced Diploma

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SECTION 2 PERSONAL DETAILS

Name (As on Identification Card/Passport) :

Identification Card No / Passport No :

Date of Birth (day/month/year) :

Nationality : Marital Status: Single / Married

Gender: M/F

Religion :

SECTION 3 CORRESPONDENCE DETAILS

Correspondence Address:

Permanent Address:

Postcode: State: Country:

Tel: (Home) (Mobile)

Email:

SECTION 4 MEDICAL HISTORY

Disability:

Other medical conditions that may be of concern: (Allergies, Asthma, Color Blindness, Heart/Kidney Condition)

SECTION 5 FINANCIAL RESOURCES - SPONSOR (For sponsored students)

Name (of Sponsor/scholarship):

NRIC no / Passport no: Relationship:

Address:

Postcode: State: Country:

Tel: (Home) (Mobile)

Email:
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SECTION 6 EMERGENCY CONTACT

Contact Person:

Relationship:

Tel: (Home) (Mobile)

Email:

SECTION 7 EDUCATION & EMPLOYMENT HISTORY

EDUCATION (Highest qualification to date)

Qualification/Program Institute/school City / Country Duration

SECTION 8 HOW DID YOU FIRST HEAR ABOUT THE ACADEMY?

Newspaper – Which newspaper?

Radio – Which Channel?

Fair/Exhibition – Which Fair/Exhibition?

Internet Search – Search Keyword used

Magazine – Which Magazine?

Word of Mouth – Whom?

Facebook – Which Account?

TV – Which Channel?

Others

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SECTION 9 CHECKLISTS

□ Payment of Admission Fee of IDR 3,500,000 (non-refundable & non-transferable)

□ 2 passport size photographs

□ Certified true copy of Identity Card / Passport

□ Documentary Evidence (if financed by scholarship/study loan)

□ Payment Method
• Full payment: CHEQUE / BANK TRANSFER / CREDIT CARD / CASH
• Installment:

□ Payment Details
• In case of cash or cheque payment: Receipt no:
• In case of bank transfer: Attach bank-in slip/bank statement of transfer.

SECTION 10 CONDITIONS OF WITHDRAWAL

1. The proportion of Course Fees Refund is shown as follows:

a) Admission fees are NOT refundable and NON-transferable
b) Paid Course fees are NOT refundable and NON-transferable
c) An applicant whose application has been accepted may defer his/her commencement of the course to
a later term within a 12-month period. All applications must be received no later than 1 month before
the commencement of the course.

SECTION 11 CONDITIONS OF ENROLMENT

Students are advised to read the policies, terms and conditions governing the admission and the student’s continued
enrolment at APCA Indonesia as set below:

1. A student is considered fully enrolled upon registration and payment of all fees and deposits as set out in
the Fee schedule. APCA Indonesia reserves the right to revise the fee payable.
2. All fees are payable in advance. Full settlement of admission fee is required upon registration, full
settlement of course fees or first installment is required latest by the intake date. Full settlement of
subsequent fees (subsequent installments) are required according to due dates given by the Accounts
department.
3. All payments are to be in the form of cash (Indonesian Rupiah), bank transfer (Telegraphic transfer) or
crossed cheque made payable to “PT. Lentera Sinergi Abadi”. Please do not send cash through the post.
4. Failure to pay fees may result in the student being barred from classes, examinations and other facilities.
5. Fees paid are NOT transferable. Admission fees are NOT refundable.
6. In the event a student is expelled or is suspended or discontinues the program / module due to disciplinary
/ academic misconduct, there shall be no refund of fees paid.
7. For all programs and modules, all fees are payable in advance and must be fully paid before or by the start
of the program / module. A penalty of IDR 100,000 will be imposed if full payment is not received by the
due date and for each day or part thereof delayed.
8. The APCA Indonesia reserves the right to review status of the student and to take necessary action if
payment is not received by the end of fifth week of the program / module. Such action may include the
barring of student from classes and facilities.

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 9. Students must abide by all academic, administrative and examination rules, regulations and policies of
APCA Indonesia in force and to be enacted in future.
10. All references to “student” or “students”, wherever relevant or applicable, shall include any parent or legal
guardian of the student in the case the student has not attained the age of majority at the time of
enrollment of student.
11. APCA Indonesia shall be under no liability whatsoever to any student for any loss or damage or death and
personal injury caused by negligent act or omission of any student sustained at the Academy’s premises.
Except for personal injury or death caused by the APCA Indonesia, its employees, or any other person
concerned whether in respect of a negligent act or omission, within the premises.
12. APCA Indonesia covers only the accidental insurance during the period of the student’s enrolment.

SECTION 12 DECLARATION BY APPLICANT

ACKNOWLEDGEMENT AND AGREEMENT

I have read, and I fully understand the above policies, terms and conditions and the nature and effects thereof.
I hereby agree to pay all fees due on the dates stipulated by APCA Indonesia.
I accept that APCA Indonesia reserves the right to revise the current fees without prior notice.
I certify that the information provided is correct and complete, that I am aware of the costs of the program, fee
schedule and payment deadlines

Signature of applicant:

Name:

Date:

SECTION 13 DECLARATION BY PARENT / GUARDIAN / SPONSOR

DECLARATION BY PARENT / GUARDIAN / SPONSOR

I hereby agree to pay all fees due to the dates stipulated by APCA Indonesia.

I also understand and agree to the conditions as stated in the admission form.

Signature of Parent/Guardian/Sponsor:

Name:

Date:

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ATTACHMENT 13 PAYMENT METHOD

Below are the pricing details of the course tuition:

Option 1 (Full Payment)

- Admission Fee IDR 3,500,000
- Academic Fee USD 10,000 - IDR 140,000,000

Option 2 (Quarterly Payment)

- Admission Fee IDR 3,500,000
- Academic Fee 1st Quarter USD 4,500 - IDR 63,000,000
- Academic Fee 2nd Quarter USD 3,000 - IDR 42,000,000
- Academic Fee 3rd Quarter USD 2,800 - IDR 39,200,000

Option 3 (Monthly Payment)

- Admission Fee IDR 3,500,000
- Down Payment USD 2,500 - IDR 35,000,000
- 1st Month USD 1,000 - IDR 14,000,000
- 2nd Month USD 1,000 - IDR 14,000,000
- 3rd Month USD 1,000 - IDR 14,000,000
- 4th Month USD 900 - IDR 12,600,000
- 5th Month USD 900 - IDR 12,600,000
- 6th Month USD 900 - IDR 12,600,000
- 7th Month USD 800 - IDR 11,200,000
- 8th Month USD 800 - IDR 11,200,000
- 9th Month USD 800 - IDR 11,200,000

I, as the sponsor, hereby acclaim that I will compensate the course tuition by (check one):
Option 1
Option 2
Option 3

Payment should be made by transfer to:

Name : PT. Lentera Sinergi Abadi
Bank : BCA Alam Sutera
Account no : 6043939888

Tangerang, __________________

Acknowledge by,

_____________________