Century Academy

Registration Form

Course

Personal Information

Salutation

Full Name (as per MyKad / Passport)

NRIC / Passport No. *without dash(-)

Citizenship

Date of Birth

Height (cm)

Weight (kg)

Gender

Marital

Contact Details

Residential Address 1

Residential Address 2

Postcode

State

Country

Mobile Phone No.

Residential Phone No.

Emergency Contact

Father Name

Contact No.

Occupation

Mother Name

Contact No.

Occupation

Remark

Educational Background

School / College / University (1st)

Dated From (1st)

Dated To (1st)

School / College / University (2nd)

Dated From (2nd)

Dated To (2nd)

Documentation Required

Passport Size Photo

Recommend photo size resolution 315px x 405px / 35mm x 45mm. JPG/PNG format.

Certificate's

Secondary school result / Further study certificate. PDF/JPG/PNG format.

IC (Front) / Passport

IC (Front) / Passport. PDF/JPG/PNG format.

IC (Back) / Passport

IC (Back) / Passport. PDF/JPG/PNG format.

* Each file size must be less than <10MB.

Application Declaration

I declare that to the best of my knowledge the information contained in this form is correct and complete. I understand that if I provide incorrect information this may result in my ineligibility for admission and/or enrolment. I also recognise that it is my responbility to provide all necessary supporting documentary evidence and I authorise the management of Centuria Academy to make reference checks and to use the information and data in this application for whatever purposes as may be deemed necessary.

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