Application

Important Note :
1. Please fill in all the mandatory fields marked . you will not be able to save/submit the application if you
missed them out or incomplete
2. Please make sure to fill in your email address correctly. After you save/submit this application form,
notification of your application code will send to the email address you provided.
3. Electronic documents required to be uploaded with this application includes: - Certified true copy of Brunei identification card or international passport
- Certified true copies of academic certificates, including university transcripts (where applicable)
and English proficiency qualification
- For international applicants, a security clearance letter from letter from the country of origin
- For in-service applicants working in the private sector, a letter of permission from the employer
4. You will be able to download a PDF version of your filled application form upon a successful submission.
5. For Brunei Government employees, printed application forms must be submitted through the respective
Ministry.

Programme of Study
Application Code EF2B68
First Choice
Second Choice

PhD In Computer Science

Apply for Session 2016 August Intake

If you have previously applied to study at UBD, please indicate the most recent year you applied :

Personal Details
Title
Name
Nationality
Brunei Identification
Card No

Master
MUHAMMAD FAISAL TAMA
INDONESIA
Citizenship
Identification Card
Colour

Race
Gender
Date of Birth
Country of Birth
Passport Number
Place of Issued
Country of Issued

Male
1983-04-30
INDONESIA
A6729757
INDONESIA
INDONESIA

Citizen

Religion
Marital Status
Country of Origin
Country of Resident

Muslim
Single
INDONESIA
INDONESIA

Date of Issued
Expiry Date

2013-11-22
2018-11-22

Contact Details
Permanent Address jl.AP.Pettarani no.27 Makassar
South Sulawesi
Indonesia
90232
Postcode
Country INDONESIA
Mailing Address

jl.AP.Pettarani no.27 Makassar

South Sulawesi
Indonesia
90232
Postcode
Country INDONESIA

Phone No.
Email
Skype ID

085299571767
inukimedical@yahoo.com

Mobile No 085299571767
04114668835
Fax No

Work Experience / Employment Details

Employer Name and Address

Post

Mode

From

To

Emergency Contact

Phone No.

Retno
Relative
JL.Racing Centre no.17/39 Makassar
South Sulawesi
Indonesia
Mobile No 081343549850
081343549850

Office No.
Email

081343549850
inukrmc@gmail.com

Name
Relationship
Address

Fax No

Next Of Kin
Application Details
Research and Publication
Please list completed research and publications, if any (please attach additional sheet if necessary).
Year

Title

Title of Publication (if

applicable)

Publications details (volume/edition/page)

Other Information
Are you currently Employed ?

No

If you are currently employed, will you stay employed while studying in UBD?
If Yes, please fill in:
For Brunei Government Employee only :
Ministry :

Department :

Latihan Dalam Perkhidmatan

(LDP) Status
For Private Sector
(Company/Organization)

Have you previously studied in UBD? No

Source of Funding
Please indicate the type of funding
Fee Paying
X Scholarship
Name of the Scholarship Scheme :

phd asian

Have you ever been awarded Brunei Government

Scholarship before?
No
X Yes
If Yes, name of the scholarship :

Master from Hasanudin University

No

Schools / Institutions Attended From Tertiary Onwards

Name of School / Institution Country

From

To

Highest Qualification Result /

Earned
Classification

English Proficiency Qualification (if applicable)

Year

Score/Grade

2014

567

GCE "O" Level

English Language
IELTS Score
TOELF Score
IGCSE Score
UBD Bridging English
Courses

Mathematics Proficiency Qualification (if applicable)

Candidates are required to have EITHER a minimum Mathematics qualification of GCE 'O' Level Credit
6 or one "pass" in a Tertiary Level Mathematics subject.
a) Please indicate if you have following
Credit 6 in Mathematics at GCE 'O' Level Examination
Grade pass in a Subsequent Level Mathematics subject
Please note : Certified true copies of results / test results must be enclosed/uploaded.

Extra-Curriculum Activities and Membership in Association

Referees
REFEREE1
Dr. Ing. Faizal Arya Samman, ST
Name
Institution Hasanuddin university
Jl. Perintis Kemerdekaan Km 10, Makassar
Address
South Sulawesi
Indonesia
Senior Lecturer
Position
Phone No (0411) 586200
Mobile No 411586200
unhas@ac.id
0411-585188
Email
Fax No

REFEREE2
Dr. Muhammad Niswar., ST. MT
Name
Institution Hasanuddin University
Jl. Perintis Kemerdekaan Km 10, Makassar
Address
South Sulawesi
Indonesia
Senior Lecturer
Position
Phone No 411586200
Mobile No 411586200
unhas@ac.id
411-585188
Email
Fax No

UBD Graduate Research Scholarship (GRS)

a) Are you applying for the UBD Graduate Research Scholarship

Yes

b) Where / How did you hear about the UBD Graduate Research Scholarship (you may tick more
than one)?
Friends
Advertisement
X Website
Others
(Please specify)

c) Have you been awarded with this scholarship or other scholarship in the past?
If "Yes", please provide further details of scholarships

Yes

Master
Name of Scholarship :
Hasanuddin university
Awarded by :
Name of programme of study : Technic Electro
2014
Academic Year :
d) Candidates are required to submit an original essay of not more than 1000 words describing why
you apply for the GRS, why you deserve to be selected for the GRS, and what you intended to do to
give back to Brunei Darussalam after you have completed your studies in UBD. (Please attach
additional sheets if necessary).
WITH ALL MY HOPES TO BE BEST LECTURER IN MY UNIVERSITY AND TO IMPROVE MY
PROFESSION AS LECTURER, I TRY TO GET THIS SCHOLARSHIP.
AND I SHALL OBEY ALL REGULATIONS FROM BRUNEI GOVERNMENT RELATED TO THIS
PROGRAM.
AS AN INDONESIAN CITIZEN AND MUSLIM,I REALLY EXPECT THE BRUNEI GOVERNMENT
CONSIDER MY APPLICATION.
AS REPRESENTATIVE OF MY COUNTRY AS GENERALLY AND ESPECIALLY MY CAMPUS, I HOPE
RELATIONSHIP BETWEEN INDONESIA AND BRUNEI WILL BE SUPPORTED TO EACH OTHER. THANK
YOU

Declaration
X Agree to the Terms
I hereby confirm all the information provided by me is correct and true to the best of my knowledge. I agree to
inform Universiti Brunei Darussalam (UBD) if there is any change to the information provided in this
application while I am studying at UBD. I also certify that UBD reserves the right to vary or reverse any
decision pertaining to my admission to UBD if the information given by myself is incorrect and untrue. I also
consent to the collection, processing and retention by UBD of my personal data under the terms of UBD.