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JENIS PERJALANAN DAN LALUAN
(TRAVEL TYPE AND ROUTE)
Jenis Perjalanan:
*
(Travel Type):
--Please Select--
Company sponsored
Company sponsored (Reciprocal Green Lane)
Government sponsored
Government sponsored (Reciprocal Green Lane)
International Student
Sea vessel crew
Diplomatic
Diplomatic (Dependent)
Sponsored by family member
Domestic Workers
Others
Negara Asal Tempat Berlepas:
*
(Origin Departure Country):
--Please Select--
Miri, Malaysia
Limbang, Malaysia
Lawas, Malaysia
Labuan, Malaysia
Other International Country
Negara Transit/ Tempat Terakhir Berlepas:
*
(Transit Country/Last Place Of Embarkation):
--Please Select--
Miri, Malaysia
Limbang, Malaysia
Lawas, Malaysia
Labuan, Malaysia
Other International Country
MAKLUMAT SYARIKAT/INDIVIDU/AGENSI YANG MENJAMIN
(SPONSOR'S DETAILS)
Nama Syarikat / Individu / Agensi:
*
(Company / Individual / Agency Name):
Alamat penjamin:
(Sponsor’s address):
No. Telefon:
*
(Phone Number)
:
Nota: No. Telefon yang dapat dihubungi pada bila-bila masa
Note: Phone Number that is available for contact at any time
Alamat E-mel:
*
(E-Mail Address)
:
MAKLUMAT FOKAL INDIVIDU YANG BOLEH DIHUBUNGI
(FOCAL PERSON CONTACT DETAILS)
Nama fokal individu:
*
(Focal individual name)
:
No. Telefon:
*
(Phone Number)
:
Alamat E-mel:
(E-Mail Address)
:
KETERANGAN INDIVIDU YANG DIPOHONKAN
(APPLICANTS DETAILS)
Nama (Seperti di dalam Passport):
*
(Name as appears on Passport)
:
Tarikh Lahir:
(Date of Birth)
:
Date
Warganegara:
*
(Nationality)
:
--Please Select--
Afghan
Albanian
Algerian
American
Andorran
Angolan
Antiguans
Argentinean
Armenian
Australian
Austrian
Azerbaijani
Bahamian
Bahraini
Bangladeshi
Barbadian
Barbudans
Batswana
Belarusian
Belgian
Belizean
Beninese
Bhutanese
Bolivian
Bosnian
Brazilian
British
Bulgarian
Burkinabe
Burmese
Burundian
Cambodian
Cameroonian
Canadian
Cape Verdean
Central African
Chadian
Chilean
Chinese
Colombian
Comoran
Congolese
Costa Rican
Croatian
Cuban
Cypriot
Czech
Danish
Djibouti
Dominican
Dutch
East Timorese
Ecuadorean
Egyptian
Emirian
Equatorial Guinean
Eritrean
Estonian
Ethiopian
Fijian
Filipino
Finnish
French
Gabonese
Gambian
Georgian
German
Ghanaian
Greek
Grenadian
Guatemalan
Guinea-Bissauan
Guinean
Guyanese
Haitian
Herzegovinian
Honduran
Hungarian
I-Kiribati
Icelander
Indian
Indonesian
Iranian
Iraqi
Irish
Israeli
Italian
Ivorian
Jamaican
Japanese
Jordanian
Kazakhstani
Kenyan
Kittian and Nevisian
Kuwaiti
Kyrgyz
Laotian
Latvian
Lebanese
Liberian
Libyan
Liechtensteiner
Lithuanian
Luxembourger
Macedonian
Malagasy
Malawian
Malaysian
Maldivian
Malian
Maltese
Marshallese
Mauritanian
Mauritian
Mexican
Micronesian
Moldovan
Monacan
Mongolian
Moroccan
Mosotho
Motswana
Mozambican
Namibian
Nauruan
Nepalese
New Zealander
Ni-Vanuatu
Nicaraguan
Nigerian
Nigerien
North Korean
Northern Irish
Norwegian
Omani
Pakistani
Palauan
Palestinian
Panamanian
Papua New Guinean
Paraguayan
Peruvian
Polish
Portuguese
Qatari
Romanian
Russian
Rwandan
Saint Lucian
Salvadoran
Samoan
San Marinese
Sao Tomean
Saudi
Scottish
Senegalese
Serbian
Seychellois
Sierra Leonean
Singaporean
Slovakian
Slovenian
Solomon Islander
Somali
South African
South Korean
Spanish
Sri Lankan
Sudanese
Surinamer
Swazi
Swedish
Swiss
Syrian
Taiwanese
Tajik
Tanzanian
Thai
Togolese
Tongan
Trinidadian or Tobagonian
Tunisian
Turkish
Tuvaluan
Ugandan
Ukrainian
Uruguayan
Uzbekistani
Venezuelan
Vietnamese
Welsh
Yemenite
Zambian
Zimbabwean
No. Pasport:
*
(Passport Number)
:
Tarikh Mansuh Pasport:
*
(Date of Expiry)
:
Date
Tarikh Pasport Dikeluarkan:
(Date of Passport Issuance)
:
Date
Status Vaksinasi COVID-19:
*
(COVID-19 Vaccination Status):
--Please Select--
Not vaccinated / belum menerima vaksinasi
Received 1 dose / Menerima 1 dos
Received 2 doses / Menerima sekurang-kurangnya 2 dos
Jenis Vaksinasi COVID-19:
*
(COVID-19 Vaccination Type):
--Please Select--
Not fully vaccinated / belum melengkapi dos vaksinasi
AstraZeneca
Covaxin
Pfizer
Moderna
Sinopharm
Sinovac
Johnson & Johnson
Other / lain-lain
Sila muatnaik sijil vaksinasi COVID-19 di laman seterusnya.
Please attach COVID-19 vaccination certificate in the next page.
KETERANGAN PEMOHON
(APPLICATION DETAILS)
Tarikh Masuk Ke Brunei Darussalam:
*
(Date of Entry to Brunei Darussalam)
:
Date
Tujuan Masuk:
*
(Purpose of Entry)
:
--Please Select--
Working
Short visit for professional/business work
International Student
Others
Kelamaan Tempoh Tinggal Yang Dipohonkan:
*
(Intended Duration of Stay)
:
Saya mengaku dan mengesahkan bahawa individu yang dipohonkan telah berada di tempat terakhir dan adalah dalam keadaan yang sihat sebelum Tiba Di Negara Brunei Darussalam selama 14 Hari.
(I declare and assure that the intended traveler will have been in good health and remained in the country of disembarkation for 14 days prior to arrival in Brunei Darussalam.).