<p> Fee: BND 50.00</p><p>ICT ACCREDITED BUSINESS (ICTAB) APPLICATION FORM FOR AAB STATUS BUSINESSES</p><p>SECTION A. GENERAL INFORMATION</p><p>BUSINESS NAME:</p><p>APPLICATION FOR ICTAB CLASS:  Class 1  Class 2  Class 3  Class 4  Class 5 (Please Tick  One Only)</p><p>TYPE OF BUSINESS AND PARTICULARS</p><p>Sole Proprietorship Partnership Limited Company</p><p>Start-up Capital BND Start-up Capital BND Paid-up Capital BND % of Local1 % of Local1 % of Local1 % % % Ownership Ownership Ownership</p><p>DATE OF AAB STATUS EXPIRY:</p><p>LIST OF SHAREHOLDER(S) AND OWNER(S)</p><p>D.O.B No. Name % of Share Designation in Business Highest Qualification Nationality (DD/MM/YY)</p><p>1 Term Local refers to Citizens and Permanent Residents of Brunei Darussalam Ver 04.12 Page 1 of 5 LIST OF FULL-TIME EMPLOYEES</p><p>D.O.E Highest D.O.B No. Name Position Nationality (DD/MM/YY Qualification (DD/MM/YY) )</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>Ver 04.12 Page 2 of 5 SECTION B. TRACK RECORD</p><p>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. </p><p>Customer Name:</p><p>Project Name:</p><p>Brief Description of Project:</p><p>Role in the Project (Please also state whether you are main contractor, sub-contractor etc):</p><p>Start Project Date: Timeframe End Date:</p><p>Project Cost</p><p>Customer Reference Contact Details:- </p><p>Name:</p><p>Designation:</p><p>Organisation: </p><p>Contact No.:</p><p>Fax No.:</p><p>Email Address: </p><p>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.</p><p>Tick if No. Documents No. of pages attached For sole proprietorships or partnerships i.e. Syarikat, Enterprise</p><p>(a) Last two (2) years Income Statement 1 (b) Last two (2) years Balance Sheet</p><p>(c) Cash Flow Statement For corporate entities i.e. Sendirian Berhad (Private Limited) and Berhad (Limited) (a) Latest Audited Financial Accounts</p><p>(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</p><p>Other supporting documents</p><p>1</p><p>2</p><p>3</p><p>SECTION D. COMPLIANCE </p><p>1. ICT Accredited Business (ICTAB) applicants are required to submit true, accurate and complete information.</p><p>2. This application form shall be signed by:</p><p> o For Sole Proprietors: Business owner;</p><p> o For Partnerships/Firms: One partner who is duly authorized by all registered owners of the firm to sign on behalf of the firm;</p><p> o For Limited Companies: One director or shareholder who has been given authority to sign on behalf of the company. </p><p>Ver 04.12 Page 4 of 5 SECTION E. DECLARATION</p><p>I hereby agree: </p><p>(i) that the information in this application and the documents submitted are true, accurate and complete;</p><p>(ii) to the Terms & Conditions of the ICT Accredited Business initiative; and</p><p>(iii) that the abovementioned business name is not blacklisted by the Government of Brunei Darussalam.</p><p>Name of Signatory: (in CAPITAL letters)</p><p>Designation in Business:</p><p>Signature: (Please also apply company seal/chop) Smart Card No. and Colour:</p><p>Date:</p><p>Ver 04.12 Page 5 of 5</p>