GOVERNMENT SCHOLARSHIP APPLICATION FORM SCH01

INSTRUCTION :
Please submit TWO (2) copies of your
completed application form and documents
to the following address :
ADMISSION & STUDENT RECORDS
Counter A, Student Central
Student Affairs Building
Universiti Brunei Darussalam
Jalan Tungku Link
Gadong BE1410
Negara Brunei Darussalam
Enquiries :
Tel - +673 2463001 Ext. 1196/1661/1849/2444
Fax - +673 2460062
Email : office.admission@ubd.edu.bn
PERSONAL PARTICULARS (Please print in BLOCK letters)
The following documents are required (Please tick the documents
that you have enclosed) :
 Completed application form
 Copy of Identification Card/Smart Card
 Copy of UBD Letter of Offer
 Copy of ‘O’ Level Certificate (Bahasa Melayu & English results)
 Copy of Certificate (Highest Qualification)
 Copy of English proficiency test result (IELTS, TOEFL) [for
applicants without ‘O’ Level English]
 Copy of UBD Transcript with classification [for Bachelor
applicants who have completed 2 semesters of study]
 Copy of Citizenship Certificate (Sijil Kerakyatan) [for new
Brunei citizens]
 Copy of Approval of Extension of Candidature Letter [for
applicants requesting extension of scholarship]
 Copy of scholarship award letter for previous study [for those
applicable]
Incomplete applications will not be processed.

Name

IC No. IC Colour
Date of
Birth (DD/MM/YYYY) Age

Nationality email
Home
Address

Tel No (Home) (Mobile)

PROGRAMME OF STUDY

UBD Registration No. Programme of Study :

Faculty Major

Study Commencement August, Year January, Year

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PREVIOUS APPLICATION

Have you ever been previously awarded Brunei Government Scholarship during study at  Yes  No
Universiti Brunei Darussalam?
Have you ever been terminated from Universiti Brunei Darussalam?  Yes  No
Have you ever been previously awarded Brunei Government Scholarship to study at overseas  Yes  No
Institutions/Universities?
Have you even been terminated from Brunei Government Scholarship?  Yes  No
If yes, please give the reason of termination :

_________________________________________________________________________________________________

ACADEMIC QUALIFICATION

1.1 HIGHEST QUALIFICATION (eg. Bachelor of Science – Second Upper Class Honours)

Please tick (/) where applicable

Qualification Results
A Level 
Higher National Diploma 
Bachelor Degree 
Master Degree 

5.2 O LEVEL EXAMINATION RESULT

Year Subject Marks & Grades

Bahasa Melayu

English Language

DECLARATION

Have you ever been convicted by a Court of law of any country?  Yes  No

If yes, please give details:

____________________________________________________________________________________________

____________________________________________________________________________________________

I hereby declare that the information provided in this application is correct and the attachments are true to the best of my
knowledge and belief, and I have not witfully suppressed any material fact. I authorise Universiti Brunei Darussalam to
obtain official records, if necessary, from any educational institution I have attended. I understand that any provision of
inaccurate and false information or omission of information will render this application invalid and that, if admitted on the
basis of such information, I can be required to withdraw from the scholarship.

Name :________________________________________ Signature :____________________________________

Date :____________________

v.May2016

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