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BRUNEI DARUSSALAM GOVERNMENT SCHOLARSHIPS

FOR FOREIGN STUDENTS TENABLE IN BRUNEI
DARUSSALAM
SESSION
APPLICATION FORM
CODE

PROGRAMME NAME

FIRST CHOICE
SECOND CHOICE

INSTRUCTIONS TO APPLICANTS
1. Each Candidate must complete 3 (Three) copies of this form to be typed or
written legibly in blue or black ink.
2. The following documents should be submitted with the form:
i.

Three recent passport size photographs.

ii.

Three certified copies of academic qualification.

iii.

Three copies of Applicants Statement of Purpose (Item 6).

iv.

Three certified copies of Birth Certificate and passport.

v.

Three copies of Security Vetting.

vi.

Certified English Translations of supporting documents (i.e.

certificates, testimonials, transcripts) must be submitted for
documents that are not in English.

1. PERSONAL DETAILS (Please use BLOCK Letters)

Name (Please underline surname):

Identification No:

Citizenship:

Date of Birth ( dd/mm/yyyy ):

Country of Birth:

Religion:

Ethnicity:

Marital Status: Single / Married / Divorced /

Widowed#

Gender: Male / Female#

Postal Address:

Telephone No:_________ - _______ ____________

(country code)

(area code)

Fax No:

_________ - _______ - ____________

(country code)

(area code)

(tel no.)

(tel no.)

Mobile No:
_________ - _______ ____________
(country code)

(area code)

(tel no.)

E-mail address (if any):

(Candidates are strongly advised to provide either a fax no. or an email address to facilitate correspondence)
Name of Parent/ Guardian/ Next of Kin#: ___________________________________________________
Relationship: ____________________________________
Occupation / Designation: __________________________
Address:
______________________________________________________________________________________
______________________________________________________________________________________

Contact Number/ Email Address:

______________________________________________________________________________________

2. ACADEMIC EXPERIENCE (Details of Schools Attended and Academic Qualifications)

A. Please state all schools attended from age of 15
Name of School/ Institute

From

To

Qualifications Obtained

B. General Certificate of Education (Ordinary Level or Equivalent)

(Please state subjects that you have passed only)
Year

Subjects

Grade

Medium

Examination Body

C. General Certificate of Education (Advanced Level or Equivalent)

(Please state subjects that you have passed only)
Year

Subjects

Grade

Medium

Examination Body

D. Other Qualifications (Certificate/ National Certificate/ National Diploma/ Higher

National Diploma/ First Degree)
Qualifications

Name of Institute &

Duration

Country

Date

Classification/

Medium of

Passed

Grade

Instruction

E. Intended Qualification
Name of Programme/ Course

Subjects

Date of Results Expected

3. LANGUAGE PROFICIENCY
Language
English

Written

Reading

Spoken

Others, Please State:

i. .
ii. .

1: Good

2: Average

3: Poor

4. ACADEMIC DISTINCTIONS OR PRIZES RECEIVED

5. PROPOSED FUTURE CAREER

6. APPLICANT STATEMENT OF PURPOSE

In an essay of up to 200 words, describe your plan of study and/ or research you propose to
pursue and relate this to your future career plan. (You may include additional relevant material for
which there was insufficient space on this form).

Please tick if additional material enclosed

7. EMPLOYMENT EXPERIENCE (Please attach additional information if required)

Employers Name and Address

Part-Time/

Position Held

Dates
From

Full-Time

To

8. EXTRA CURRICULAR ACTIVITIES AND MEMBERSHIP IN ASSOCIATION

(Please attach additional information if required)
Year

Types of Activities (Sports, Cultural,

Level of Participation (e.g. Club, District,

Community Services etc.)

National, Regional, International etc.)

9. MEMBERSHIP IN ASSOCIATION/ PROFESSIONAL BODIES

(Please attach additional information if required)
Year

Association/ Professional Bodies

Position Held

THESIS RESEARCH

(Y/N)

If you are working on a known thesis topic, attach a 500 words description

Thesis Description enclosed

10. REFERENCES (Originals of reference letters are required to be sent by the applicable
referee) Please give details of two (2) people who can act as referees to support your application.
You should contact them yourself and enclose the references (Form C1) with the application form to
the Scholarship Section, Ministry of Education. Please include their telephone, fax and e-mail
addresses so that we can follow up references if necessary. Applications cannot be considered

unless references are received. Please pass a copy of the Statement by Referee to each referee
for him or her to fill in.
Name of Reference

Job Title & Organisation

Telephone & Fax

E-mail

SECTION 11 14 TO BE COMPLETED BY CANDIDATES WHO INTENDED TO

APPLY FOR HIGHER DEGREE PROGRAMMES ONLY
11. ACADEMIC AWARDS/ SCHOLARSHIP ACHIEVED IF ANY
Academic Awards/ Scholarship

Institution Name

Date Awarded

12. PLEASE LIST DOWN COMPLETED RESEARCH AND PUBLICATIONS IF

ANY
Name of Research/ Publications

Date Completed

13. HAVE YOU PREVIOUSLY APPLIED FOR ADMISSION AS A

POSTGRADUATE STUDENT OVERSEAS OR LOCALLY?
Y Yes

If yes, Please State:

N No
i. Year applied:
ii. Name of Programme:
iii. Were you accepted?
iv. Name of Institution: .

14. RESEARCH PROPOSAL

i.

Proposed field of study:

ii.

Topic for Research:

15. DECLARATION
I hereby certify that all the statements made on this application and in the attached
documents are true and correct. I have read all the terms and conditions laid down by the
Brunei Government Scholarship for Foreign Students (ASEAN, OIC, Commonwealth and
others) for which I now apply and I agree to abide by all the conditions of the award. I shall
return to my home country as soon as I complete my scheduled programme and will not
extend my stay without valid reasons.

Date: ..

Signature: .

C1
BRUNEI DARUSSALAM GOVERNMENT SCHOLARSHIP FOR FOREIGN STUDENTS REFERENCE LETTER

Assessment on the applicants academic ability.

1.

Applicants Name: ..
Country: ..............................................................................................................................................................
Courses Applied: ................................................................................................................................................

2.

In what capacity do you know the applicant?

(E.g. Teacher, Supervisor, Principal etc)..

3.

How long have you known the applicant? ...

4.

Please evaluate the applicants performance by putting an X in the appropriate spaces below. Extra boxes
are available for you to add, if you wish, up to three other qualities which you may find relevant to the
assessment of the candidate (E.g. All-round ability, ingenuity, accountability, manual dexterity etc.)

Assessment on:

Excellent

Very Good

Good

Average

Below
Average

Academic Record
English Proficiency
Creative Thinking
Research Ability
Industry/ Application
Judgement
Independent
Honesty
Motivation
Self Discipline

5.

Is the applicants proficiency in English Language (oral and written) adequate to meet the standard
required? Please comment.

6.

Please give your overall assessment on the applicants academic ability.

10

Referees Name:
Designation:
Address: ..
Date: ..

Signature: .

THANK YOU FOR YOUR ASSISTANCE. YOU MAY ENCLOSE THE COMPLETED REFERENCE
LETTER IN A SEALED ENVELOPE AND ATTACH TO THIS APPLICATION FORM OR YOU MAY
SEND THE COMPLETED FORM TO:

Technical Assistance Department, Ministry of

Foreign Affairs and Trade, Jalan Subok, Bandar Seri Begawan, BD2710, Brunei
Darussalam. Tel No.: (6732) 2261039. E-mail: [email protected]

11

C2
BRUNEI DARUSSALAM GOVERNMENT SCHOLARSHIP FOR FOREIGN STUDENTS REFERENCE LETTER
Assessment on the applicants academic ability.
7.

Applicants Name: ..
Country: ..............................................................................................................................................................
Courses Applied: ................................................................................................................................................

8.

In what capacity do you know the applicant?

(E.g. Teacher, Supervisor, Principal etc)..

9.

How long have you known the applicant? .

10. Please evaluate the applicants performance by putting an X in the appropriate spaces below. Extra boxes
are available for you to add, if you wish, up to three other qualities which you may find relevant to the
assessment of the candidate (E.g. All-round ability, ingenuity, accountability, manual dexterity etc.)

Assessment on:

Excellent

Very Good

Good

Average

Below
Average

Academic Record
English Proficiency
Creative Thinking
Research Ability
Industry/ Application
Judgement
Independent
Honesty
Motivation
Self Discipline

11. Is the applicants proficiency in English Language (oral and written) adequate to meet the standard
required? Please comment.

12

12. Please give your overall assessment on the applicants academic ability.

Referees Name:
Designation:
Address: ..
Date: ..

Signature: .

THANK YOU FOR YOUR ASSISTANCE. YOU MAY ENCLOSE THE COMPLETED REFERENCE
LETTER IN A SEALED ENVELOPE AND ATTACH TO THIS APPLICATION FORM OR YOU MAY
SEND THE COMPLETED FORM TO:

Technical Assistance Department, Ministry of

Foreign Affairs and Trade, Jalan Subok, Bandar Seri Begawan, BD2710, Brunei
Darussalam. Tel No.: (6732) 2261039. E-mail: [email protected]

TO BE COMPLETED BY THE NOMINATING GOVERNMENT

13

(The following endorsement must be completed on the top copy of the application by the Nominating Agency)
This candidate is nominated for consideration for an award and the following details are confirmed:

Initials of verifying officer

1.

The underlining of the candidates name in question 1 correctly

identifies his or her formal family name.

2.

Evidence verified concerning date and place of birth and

nationality.

3.

References enclosed from the two (2) persons named in

questions 1, 7 and 9.

4.

Candidates medical certificate attached (if required at this stage)

5.

Copies of the university or college transcript attached to each

application form.

6.

The candidate has sufficient language proficiency to enable

him/her to profit from his/her proposed course of study if given
in:
(a)

English

(b)
7. The candidate is / is not in Government employment (delete appropriately).
.

16. OFFICIAL DECLARATION (to be completed by the nominating government)

14

The _________________________________________________________________________________
( Name of Department/ Ministry)
nominates _________________________________________________________________ on behalf of
____________________________________ for the Brunei Darussalam Government Scholarships Award.
(Country)
__________________________________________
(Name)

_________________________________________
(Signature and Ministrys stamp)

__________________________________________
(Designation)

_________________________________________
(Address of Department / Ministry)

__________ - ___________ - _________________

(Ctry Code)
(Area Code) (Office Telephone No.)

__________ - ___________ - __________________

(Ctry Code)
(Area Code)
(Office Fax No.)

PLEASE NOTE:
This application form must be duly completed and endorsed by the Ministry of Foreign Affairs or the
relevant agency responsible for the Brunei Darussalam Government Scholarships in your country. Please
attach relevant supporting documents, which are to be submitted with the form. INCOMPLETE AND/OR
UNENDORSED FORMS CANNOT BE PROCESSED.

15

BRUNEI DARUSSALAM BEASISWA PEMERINTAH UNTUK MAHASISWA ASING

dipertahankan DI BRUNEI DARUSSALAM
SESI

FORMULIR PERMOHONAN

KODE PROGRAM NAMA

PILIHAN PERTAMA
PILIHAN KEDUA

INSTRUKSI UNTUK PEMOHON

1. Setiap Calon harus menyelesaikan 3 (Tiga) salinan formulir ini untuk diketik atau ditulis
terbaca dengan tinta biru atau hitam.
2. Dokumen-dokumen berikut harus disampaikan dengan bentuk:
i. Tiga foto terakhir ukuran paspor.
ii. Tiga bersertifikat salinan kualifikasi akademik.
iii. Tiga salinan Pemohon Pernyataan Tujuan (Item 6).
iv. Tiga bersertifikat salinan Akte Kelahiran dan paspor.
v. Tiga salinan Keamanan Pemeriksaan.
vi. Terjemahan Bahasa Inggris Certified dokumen pendukung (sertifikat yaitu, testimonial,
transkrip) harus diserahkan untuk dokumen yang tidak dalam bahasa Inggris.
1. DETAIL PRIBADI (Harap Surat gunakan BLOK)
Nama (Harap garis bawahi nama keluarga):

16

Identifikasi No: Kewarganegaraan:

Tanggal Lahir (dd / mm / yyyy): Negara Lahir:
Agama: Etnis:
Marital Status: Single / Menikah / Cerai / Janda # Jenis Kelamin: Pria / Wanita #
Postal Address:
Telepon Tidak :_________ - _______ - ____________
(Kode negara) (kode area) (no telp.)
Mobile No: _________ - _______ - ____________
(Kode negara) (kode area) (. No telp) Fax No: _________ - _______ ____________
(Kode negara) (kode area) (no telp.)
E-mail (jika ada):
(Calon sangat disarankan untuk memberikan baik faks tidak ada atau alamat email untuk
memudahkan korespondensi.)
Nama Orang Tua / Wali / Berikutnya Kin #:
___________________________________________________
Hubungan: ____________________________________
Pekerjaan / Penunjukan: __________________________
Alamat:
__________________________________________________________________________
____________
__________________________________________________________________________
____________
Nomor Kontak / Alamat Email:
__________________________________________________________________________

17

____________
2. PENGALAMAN AKADEMIK (Rincian Sekolah Dihadiri dan Kualifikasi Akademik)
A. Silakan sebutkan semua sekolah hadir dari usia 15
Nama Sekolah / Lembaga Dari Untuk Kualifikasi Memperoleh

B. General Certificate of Education (Tingkat Biasa atau Setara)

(Harap subyek menyatakan bahwa Anda telah lulus saja)
Tahun Subyek Tubuh Ujian Kelas Menengah

C. General Certificate of Education (Tingkat lanjut atau Setara)

(Harap subyek menyatakan bahwa Anda telah lulus saja)
Tahun Subyek Tubuh Ujian Kelas Menengah

18

D. Lain-lain Kualifikasi (Sertifikat / Certificate Nasional / Diploma Nasional / Diploma

Tinggi Nasional / Degree Pertama)
Kualifikasi Nama Lembaga Klasifikasi & Tanggal Negara Jangka Lulus / Sedang Grade
Instruksi

E. Ditujukan Kualifikasi
Nama Program / Tanggal Kursus Subyek Hasil yang Diharapkan

3. Bahasa KECAKAPAN
Ditulis Membaca Bahasa Spoken
Bahasa Inggris
123
123
123
Lainnya, Silahkan Negara:
i. ... ... ... ... ... ....
ii. ... ... ... ... ... ....
123

19

123
123
123
123
123
1: Baik 2: Rata-rata 3: Miskin

4. Perbedaan AKADEMIK ATAU HADIAH DITERIMA

5. RENCANA KARIR MASA DEPAN

6. PEMOHON PERNYATAAN TUJUAN

Dalam sebuah esai hingga 200 kata, menjelaskan rencana studi Anda dan / atau penelitian
yang Anda usulkan untuk mengejar dan berhubungan ini untuk merencanakan karir masa
depan Anda. (Anda mungkin termasuk bahan yang relevan tambahan yang ada tidak cukup
ruang pada formulir ini).

Silakan tandai jika bahan tambahan tertutup

20

7. PENGALAMAN KERJA (Mohon lampirkan informasi tambahan jika diperlukan)

Majikan nama dan Jabatan Alamat Dimiliki Paruh-Waktu /
Full-Time Tanggal
Dari Untuk

8. Ekstra kurikuler KEGIATAN DAN KEANGGOTAAN DALAM ASOSIASI

(Mohon lampirkan informasi tambahan jika diperlukan)
Tahun Jenis Kegiatan (Olahraga, Budaya, Pelayanan Komunitas dll) Tingkat Partisipasi
(misalnya Club, Distrik, Nasional, Daerah, Internasional dll)

9. KEANGGOTAAN DALAM ASOSIASI / BADAN PROFESIONAL

(Mohon lampirkan informasi tambahan jika diperlukan)
Tahun Asosiasi / Badan-badan Profesional Posisi Dimiliki

PENELITIAN TESIS (Y / N)

21

Jika Anda bekerja pada topik tesis diketahui, melampirkan deskripsi 500 kata Deskripsi
Tesis tertutup

10. REFERENSI (Asli surat referensi diperlukan untuk dikirim oleh wasit yang berlaku)
Tolong beri rincian dua (2) orang yang dapat bertindak sebagai wasit untuk mendukung
aplikasi Anda. Anda harus menghubungi mereka sendiri dan melampirkan referensi
(Formulir C1) dengan formulir aplikasi ke Bagian Beasiswa, Departemen Pendidikan. Harap
mencantumkan nomor telepon mereka, faks dan alamat e-mail sehingga kita dapat
menindaklanjuti referensi jika perlu. Aplikasi tidak bisa dianggap kecuali referensi diterima.
Mohon forward salinan Pernyataan Wasit untuk wasit masing-masing untuk dia untuk
mengisi masuk
Referensi Nama Jabatan & Organisasi Telepon & Fax E-mail

BAGIAN 11 - 14 UNTUK DIISI OLEH CALON YANG DIMAKSUDKAN UNTUK

BERLAKU UNTUK TINGKAT TINGGI HANYA PROGRAM
11. PENGHARGAAN AKADEMIK / BEASISWA DICAPAI JIKA ADA
Penghargaan Akademik / Lembaga Beasiswa Diberikan Tanggal Nama

12. SILAKAN DAFTAR PENELITIAN DOWN DIISI DAN PUBLIKASI JIKA ADA
Nama Penelitian / Publikasi Tanggal Selesai

22

13. SUDAHKAH ANDA SEBELUMNYA DITERAPKAN UNTUK PENDAFTARAN

SEBAGAI MAHASISWA PASCASARJANA LUAR NEGERI atau secara lokal?
Y - Ya Jika ya, silahkan Negara:
N - Tidak ada
i. Tahun yang digunakan: ... ... ... ... ... ... ... ... ...
ii. Nama Program: ... ... ... ... ... ... ... ... ... ...
iii. Apakah Anda diterima? ... ... ... ... ... ... ... ... ... ... ...
iv. Nama Lembaga: ... ... ... ... ... ... ... ... ... ... ....
14. PROPOSAL PENELITIAN
i. Usulan bidang studi:
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ...
ii. Topik Penelitian:
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

23

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ...
15. DEKLARASI
Saya dengan ini menyatakan bahwa semua pernyataan yang dibuat pada aplikasi ini dan
dalam dokumen yang dilampirkan adalah benar dan tepat. Saya telah membaca semua syarat
dan kondisi yang ditetapkan oleh Pemerintah Brunei Beasiswa untuk Mahasiswa Asing
(ASEAN, OKI, Persemakmuran dan lain-lain) yang sekarang saya menerapkan dan saya
setuju untuk mematuhi semua kondisi penghargaan. Aku akan kembali ke negara asal saya
secepat saya menyelesaikan program saya dijadwalkan dan tidak akan memperpanjang masa
tinggal saya tanpa alasan yang sah.

Tanggal: ... ... ... ... ... ... ... ... .. Tanda tangan: ... ... ... ... ... ... ... ... ... ....
C1
BRUNEI DARUSSALAM PEMERINTAH BEASISWA UNTUK SURAT REFERENSI
'MAHASISWA ASING

Penilaian kemampuan akademik pemohon.

1. Nama
Pemohon: ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ..
Negara: ................................................ .................................................. ..................................
................ ..........
Terapan: ............................................... .................................................. ..................................
.............

24

2. Dalam kapasitas apa Anda tahu pemohon?

(Misalnya Guru, Pengawas, Kepala Sekolah
dll) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ..
3. Berapa lama Anda telah mengenal
pemohon? ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
4. Silakan mengevaluasi kinerja pemohon dengan menempatkan tanda X di tempat yang
sesuai di bawah ini. kotak tambahan tersedia bagi Anda untuk menambah, jika Anda ingin,
sampai dengan tiga kualitas lain yang Anda mungkin menemukan relevan dengan penilaian
calon (Eg All-kemampuan bulat, kecerdikan, akuntabilitas, ketangkasan manual dll)
Penilaian: Rata-rata Bagus Bagus Sangat Bagus Dibawah Rata-rata
Rekam Akademik
Kemampuan berbahasa Inggris
Berpikir Kreatif
Penelitian Kemampuan
Industri / Aplikasi
Penghakiman
Independen
Kejujuran
Motivasi
Disiplin Diri

25

5. Apakah kemampuan pemohon dalam Bahasa Inggris (lisan dan tulisan) yang cukup untuk
memenuhi standar yang diperlukan? Silakan komentar.
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
6. Harap memberikan penilaian secara keseluruhan pada kemampuan akademik pemohon.
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Wasit Nama: ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
Penunjukan: ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
Alamat: ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ..
Tanggal: ... ... ... ... ... ... ... ... ... ... .. Tanda

26

tangan: ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ....

TERIMA KASIH UNTUK BANTUAN ANDA. ANDA MUNGKIN menyertakan surat

REFERENSI DIISI dalam amplop tertutup dan melekat FORMULIR PERMOHONAN INI
ATAU MUNGKIN ANDA KIRIM FORMULIR DIISI KE: Departemen Bantuan Teknis,
Departemen Luar Negeri dan Perdagangan, Subok Jalan, Bandar Seri Begawan, BD2710,
Brunei Darussalam. Tel No: (6732) 2261039. E-mail: tad.scholarship @ mfa.gov.bn

C2
BRUNEI DARUSSALAM PEMERINTAH BEASISWA UNTUK SURAT REFERENSI
'MAHASISWA ASING
Penilaian kemampuan akademik pemohon.
7. Nama
Pemohon: ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ..
Negara: ................................................ .................................................. ..................................
................ ..........
Terapan: ............................................... .................................................. ..................................
.............
8. Dalam kapasitas apa Anda tahu pemohon?
(Misalnya Guru, Pengawas, Kepala Sekolah
dll) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ..

27

9. Berapa lama Anda telah mengenal

pemohon? ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ....
10. Silakan mengevaluasi kinerja pemohon dengan menempatkan tanda X di tempat yang
sesuai di bawah ini. kotak tambahan tersedia bagi Anda untuk menambah, jika Anda ingin,
sampai dengan tiga kualitas lain yang Anda mungkin menemukan relevan dengan penilaian
calon (Eg All-kemampuan bulat, kecerdikan, akuntabilitas, ketangkasan manual dll)
Penilaian: Rata-rata Bagus Bagus Sangat Bagus Dibawah Rata-rata
Rekam Akademik
Kemampuan berbahasa Inggris
Berpikir Kreatif
Penelitian Kemampuan
Industri / Aplikasi
Penghakiman
Independen
Kejujuran
Motivasi
Disiplin Diri

11. Apakah kemampuan pemohon dalam Bahasa Inggris (lisan dan tulisan) yang cukup
untuk memenuhi standar yang diperlukan? Silakan komentar.
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

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... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
12. Harap memberikan penilaian secara keseluruhan pada kemampuan akademik pemohon.
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Wasit Nama: ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
Penunjukan: ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
Alamat: ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ..
Tanggal: ... ... ... ... ... ... ... ... ... ... .. Tanda
tangan: ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ....

TERIMA KASIH UNTUK BANTUAN ANDA. ANDA MUNGKIN menyertakan surat

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REFERENSI DIISI dalam amplop tertutup dan melekat FORMULIR PERMOHONAN INI
ATAU MUNGKIN ANDA KIRIM FORMULIR DIISI KE: Departemen Bantuan Teknis,
Departemen Luar Negeri dan Perdagangan, Subok Jalan, Bandar Seri Begawan, BD2710,
Brunei Darussalam. Tel No: (6732) 2261039. E-mail: tad.scholarship @ mfa.gov.bn

(The dukungan berikut harus diselesaikan pada salinan atas aplikasi oleh Badan Nominasi)
calon ini dinominasikan untuk pertimbangan bagi penghargaan dan rincian sebagai berikut
dikonfirmasi:

Inisial petugas verifikasi

1. Yang menggarisbawahi nama kandidat pada pertanyaan 1 dengan benar mengidentifikasi
nama keluarganya formal.
2. Bukti diverifikasi tentang tanggal dan tempat lahir dan kebangsaan.
3. Referensi tertutup dari dua orang (2) disebutkan dalam pertanyaan 1, 7 dan 9.
4. sertifikat kesehatan calon peserta terlampir (jika diperlukan pada tahap ini)

30

5. Salinan transkrip universitas atau perguruan tinggi yang melekat pada setiap formulir
aplikasi.
6. Peserta memiliki kemampuan bahasa yang cukup untuk memungkinkan dia untuk
keuntungan dari nya / program studi yang diusulkan nya jika diberikan dalam:
(A)
Bahasa Inggris
(B)
7. Peserta adalah / tidak dalam pekerjaan Pemerintah (menghapus tepat).
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... ... ... ... ....

16. PERNYATAAN RESMI (untuk diselesaikan oleh pemerintah pencalonan)

31

__________________________________________________________________________
_______ The
(Nama Departemen / Kementerian)

menominasikan
_________________________________________________________________ atas nama

____________________________________ Untuk Pemerintah Brunei Darussalam

Beasiswa Award.
(Negara)

__________________________________________
_________________________________________
(Nama) (Tanda tangan dan stempel Departemen)

__________________________________________
_________________________________________
(Penetapan) (Alamat Departemen / Kementerian)

__________ - ___________ - _________________ __________ - ___________ __________________

(Kode Ctry) (Kode Area) (Kantor Telepon No) (Kode Ctry) (Kode Area) (Office Fax No)

32

HARAP DICATAT:
Formulir ini harus diisi dengan lengkap dan didukung oleh Departemen Luar Negeri atau
instansi terkait bertanggung jawab atas Brunei Darussalam Beasiswa Pemerintah di negara
Anda. Harap lampirkan dokumen pendukung yang relevan, yang harus disampaikan dengan
formulir. BENTUK LENGKAP DAN / ATAU UNENDORSED TIDAK DAPAT
OLAHAN.

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