Fee: BND 50.00
ICT ACCREDITED BUSINESS (ICTAB) APPLICATION FORM FOR AAB STATUS BUSINESSES
SECTION A. GENERAL INFORMATION
BUSINESS NAME:
APPLICATION FOR ICTAB CLASS: Class 1 Class 2 Class 3 Class 4 Class 5 (Please Tick One Only)
TYPE OF BUSINESS AND PARTICULARS
Sole Proprietorship Partnership Limited Company
Start-up Capital BND Start-up Capital BND Paid-up Capital BND % of Local1 % of Local1 % of Local1 % % % Ownership Ownership Ownership
DATE OF AAB STATUS EXPIRY:
LIST OF SHAREHOLDER(S) AND OWNER(S)
D.O.B No. Name % of Share Designation in Business Highest Qualification Nationality (DD/MM/YY)
1 Term Local refers to Citizens and Permanent Residents of Brunei Darussalam Ver 04.12 Page 1 of 5 LIST OF FULL-TIME EMPLOYEES
D.O.E Highest D.O.B No. Name Position Nationality (DD/MM/YY Qualification (DD/MM/YY) )
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Ver 04.12 Page 2 of 5 SECTION B. TRACK RECORD
Note: This section is to be reproduced according to the number of projects that have been completed over the past five (5) years. Currently ongoing projects may also be included.
Customer Name:
Project Name:
Brief Description of Project:
Role in the Project (Please also state whether you are main contractor, sub-contractor etc):
Start Project Date: Timeframe End Date:
Project Cost
Customer Reference Contact Details:-
Name:
Designation:
Organisation:
Contact No.:
Fax No.:
Email Address:
SECTION C. DOCUMENTS TO BE SUBMITTED Ver 04.12 Page 3 of 5 Kindly check that all required documents are attached with the application form and please list down the number of pages submitted.
Tick if No. Documents No. of pages attached For sole proprietorships or partnerships i.e. Syarikat, Enterprise
(a) Last two (2) years Income Statement 1 (b) Last two (2) years Balance Sheet
(c) Cash Flow Statement For corporate entities i.e. Sendirian Berhad (Private Limited) and Berhad (Limited) (a) Latest Audited Financial Accounts
(b) Latest Interim Report Copy of Form of Annual Return of a Company Having Share Capital (c) (Companies Act, Fifth Schedule) 2 Copies of business track record i.e. Section C of the application form
Other supporting documents
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SECTION D. COMPLIANCE
1. ICT Accredited Business (ICTAB) applicants are required to submit true, accurate and complete information.
2. This application form shall be signed by:
o For Sole Proprietors: Business owner;
o For Partnerships/Firms: One partner who is duly authorized by all registered owners of the firm to sign on behalf of the firm;
o For Limited Companies: One director or shareholder who has been given authority to sign on behalf of the company.
Ver 04.12 Page 4 of 5 SECTION E. DECLARATION
I hereby agree:
(i) that the information in this application and the documents submitted are true, accurate and complete;
(ii) to the Terms & Conditions of the ICT Accredited Business initiative; and
(iii) that the abovementioned business name is not blacklisted by the Government of Brunei Darussalam.
Name of Signatory: (in CAPITAL letters)
Designation in Business:
Signature: (Please also apply company seal/chop) Smart Card No. and Colour:
Date:
Ver 04.12 Page 5 of 5