Training Application Form

MAXIMUS INTERNATIONAL LLC www.i-mxms.com

TRAINING APPLICATION FORM General Information The following information is important. Please read it carefully before you complete your application form. Should you need help in completing it, Maximus administrators are always available to advise you. o We accept all correspondence in English or Chinese. For all other languages we will need correspondence in support of the application to be in English or accompanied by a certified translation. o Please ensure that you have completed all the applicable sections in the form. Complete Part A and Part B if you are applying on your own behalf. Complete Part C if you are applying through an organization. Do not fill in the boxes with information such as ‘see attached’, because we will not be able to process the form. If there are not enough spaces in any of the section to write in all your details, enclose full details in the additional attachments (which will need to be verified by your sponsors). You should only sign the form when you have checked that all relevant sections have been completed correctly. o Complete Part F if you are applying for any government funding. o When we receive your completed application, an acknowledgement will be send to you. We will inform you if your application has been successful as soon as the process is completed. Registration

Places will be reserved for the above participant(s) upon receipt of the registration form. The seat will only be secured upon receipt of the full payment for the courses, at least 2 weeks prior to the commencement of the training, based on first come first serve basis. We will confirm the status of the course 2 weeks prior to course commencement and notify the participants involved.

Refund and Cancellation Policy o If cancellation request is made two weeks prior to class commencement, participant will be allowed to appeal for 100% refund. o If cancellation or change of date is initiated by the participants for less than two weeks prior to class commencement, the participant shall either nominate a replacement, or pay an administrative fee of SGD100 per course day for the change of date. o Due to special circumstances, the participant is unable to complete the training within schedule period, the participant shall pay an administrative fees of SGD100 per course day for every day of non-attendance. This fee shall be paid in the next make-up public class attended. o Maximus reserved the rights to change or cancel the training programme due to unforeseen circumstances.

Contact Information Contact the Relationship Manager from the respective countries Country Mobile Office Number Fax Number Singapore +65 8124 4528 +65 6396 0938 +65 6396 0563 Malaysia +60 (0)3 2116 3455 +60 (0)3 2116 5999 Indonesia +65 6396 0938 +65 6396 0563 Thailand +66 (0)2 6343589 +66 (0)2 6343590

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Application For : Select Your Training Course Here

Note: The form must be completed and all pages must be sent to Maximus for registration. Part A Your Personal Details Name Mr. Mrs. Mdm Ms. (To appear in Certificate) Citizenship Citizen Local Permanent Resident Work Permit/ Employment Pass Others, please specify: Registered Company Name (in Full) Designation Contact Email Part B Course Required Information Course Date (DD-MM-YYYY) Special Diet Halal Indian Vegetarian (Specify if required) Others, please specify: IRCA Registration (Applicable for ISMS Lead Auditor Course only; Require Maximus to register applicant for IRCA “Provisional Auditor”? This is mandatory for CITREP application) Part C Billing Information (Only applicable if billing is not performed by person attending the course) Contact Person Contact

Billing Address

Signature Date (DD-MM-YYYY)

Part D For Official Use Only (To be filled by Sales Personnel handling the application) Total Course Fee Reference to “Refer a Friend” Form (only applicable if applicant is referred under this scheme)

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Part F Funding Information (Applicable for ISO 27001:2005 ISMS Lead Auditor Course only; CITREP – for Singaporean and Singapore PR only) Funding Application CITREP Singapore only HRDF Malaysia only MDEC Malaysia only Name (as in Identification) Identification No/ Fin Employment Status Employed Retrenched Unemployed Self Employed Scheme Self-Sponsored Company Sponsored (Company Sponsored Scheme) Additional Information Name of Sponsoring Organization

(Official registered entity name) (Company Sponsored Scheme) Information for Funding Processing Contact Person Designation Contact Email Address

Notes: Ensure that you clearly understood the funding terms and conditions. Maximus is not responsible for your funding application.

Maximus Over The World

SINGAPORE MALAYSIA 8 Burn Road Suite: 33-01, 33rd Floor #13-10/11 Trivex Menara Keck Seng Singapore 369977 203, Jalan Bukit Bintang 55100 Kuala Lumpur

INDONESIA THAILAND Komplek Ruko Rawasari Mas B-24 7th Floor Room A3, Boonmitr Building, Jakarta 10570 138 Silom Road, Suriyawongse, Bangrak, Bangkok 10500, Thailand 138 อาคารบญมตร ชน 7 หอง เอ 3 ถนนสลม แขวงสรยวงศ เขต บางรก กทม. 10500

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