Registration Form (REGULATORY COMPLIANCE IN SKILLS DEVELOPMENT BUSINESS)

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Please complete this form in English. Please also make sure all details are Correct before you click on Submit.

Have you travelled out of the country within the past 14 days? *

Yes

If Yes, where did you travel?

For the past 14 day are there any symptoms such as fever, cough? *

Yes

COURSE NAME *

COURSE DATE (DD-MM-YYYY) *

COURSE LANGUAGE *

FULL NAME AS PER NRIC / WORK PERMIT / PASSPORT *

NRIC / FIN / PASSPORT NO. *

MOBILE NO. *

BIRTH-DATE (DD-MM-YYYY) *

NATIONALITY *

SINGAPOREAN

SINGAPORE PR

MALAYSIAN

CHINESE

FILIPINO

INDIAN

THAI

VIETNAM

Other:

Gender *

Race *

CHINESE

MALAY

INDIAN

EURASIAN

VIETNAMESE

Thai

Other:

INDIVIDUAL / COMPANY? (If Company Please State the Full Company's Name) *

Email *

Postal Code

EDUCATION *

SALARY

EMPLOYMENT TITLE *

Reasons for selecting this course.

Improve skills for better work performance.

Planning for promotion / higher responsibilities

To get a better job

To obtain a qualification to take other courses

To prepare myself for better opportunities

Other:

I acknowledge that I have been informed *

1. Training Location.

2. Course outline, modules, and duration.

3. Course application requirements and procedures. a. At least 21 years old. b. At least secondary school education c. Able to speak, listen and read English at a proficiency level not lower than the Employability Skills Workforce Skills Qualification Workplace Literacy Level (WPL Level 4) d. Work experience of at least 3 years.

4. Availability of Student Support Service.

5. Qualification obtained / Pathway after completion of course.

6. Fee structure / Payment methods / Fees Protection Scheme (if applicable) / Skills Future Credit

7. Subsidy Requirements - PR / Singaporean- 75% Attendance- Different subsidies - Make-up classes not available for participants who missed lessons.

Required

DECLARATION/ ACCEPTANCE 1. I hereby declare that the above personal information given is true and correct. 2. I hereby consent that Xprienz Pte Ltd is allowed to use the information provided above for all matters related to the course(s) I have attended. 3. I hereby acknowledge that the training provider will not be held liable to resubmit the result should there is error found on the Name and/or identification number after the course has ended. 4.I hereby consent to XpRienz's use of any images or videos taken before, during or after the course. *

AGREE

I would like to receive marketing information about course offerings by Xprienz Pte Ltd *

Yes

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