PASAS INSTITUTE REGISTRATION FORM

(1)

Educating and Developing Professional since 2003

FORM-PASAS-2021 Page 1 of 2

PASAS INSTITUTE REGISTRATION FORM

PLEASE COMPLETE THE FORM IN CAPITAL LETTERS

PROGRAM APPLIED FOR: Certified Associate SupplyChain(CASC) PART A: APPLICANT DETAILS

First Name Last Name

Gender: Male/Female Nationality:

NRIC / FIN No:

Date of Birth Age:

Email Address: (Institute) (Personal)

Contact Number: (H) (HP)

Corresponding Address:

PART B: EDUCATIONAL RECORD

Institution Country Certificate Major Year of Graduation

PART C: APPLICANT DECLARATION

I, _______________________________________________________, ID No. ______________________________________

(Applicant Name)

Declare that:

a) All information and particulars provided in this form are true, complete and accurate, and that I have not withheld or distorted any information or facts. I understand that the application will not be accepted if any information is found to be untrue.

b) I have read and agree to all the contents, terms and conditions set out in the form, and in particular, agree to abide by the Conditions set out for this program.

c) I understand that PASAS shall be entitled to reject any application without assigning any reason to it.

d) I agree to comply and abide by the decision of PASAS concerning this application. (Refer overleaf for details of the Terms and Conditions).

e) At this moment, confirm that I have read, understood, and agreed to abide by the criteria as stated.

_____________________________ ________________________________

(Signature of Applicant) (Date)

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Educating and Developing Professional since 2003

FORM-PASAS-2021 Page 2 of 2

For further information and enquiries, please get in touch with us:

Educating and Developing Professionals

PASAS INSTITUTE 7 Temasek Boulevard

#12-07 Suntec Tower One Singapore 038987 www.pasas.sg

Registration No: 53401578J

FOR PASAS OFFICIAL USE ONLY

Assessed by: _____________________________________ Grade: ___________________________________________

Receipt Number: __________________________________ Date: ___________________________________________

Approved by: _____________________________________

PASAS Certification Assessment Board