ETP Registration Form

Jenis Perjalanan:*
(Travel Type):

MAKLUMAT AGENSI YANG MENJAMIN (SPONSOR'S DETAILS)

Nama Agensi / Syarikat:*
(Agency / Company Name):

Alamat Agensi / Syarikat:
(Agency / Company 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 AUTORITI YANG MENGESAHKAN (ENDORSING AUTHORITY DETAILS)

Nama Fokal Agensi yang boleh dihubungi:*
(Agency's individual contact 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):

Warganegara:*
(Nationality):

No. Pasport:*
(Passport Number):

Tarikh Mansuh Pasport:*
(Date of Expiry):

Tarikh Pasport Dikeluarkan:
(Date of Passport Issuance):

Status Vaksinasi COVID-19:*
(COVID-19 Vaccination Status):

Jenis Vaksinasi COVID-19:*
(COVID-19 Vaccination Type):

Sila muatnaik sijil vaksinasi COVID-19 di laman seterusnya. Please attach COVID-19 vaccination certificate in the next page.

Alamat Rumah Penjamin di Brunei:
(Sponsor Home Address in Brunei):

Alamat Emel:*
(Email Address):

Nama Tempat Bekerja (jika berkenaan):
(Place of Employment (if applicable):

Pekerjaan:
(Occupation):

KETERANGAN PEMOHON (APPLICATION DETAILS)

Tujuan Masuk:*
(Purpose of Entry):

Kelamaan Tempoh Tinggal Yang Dikehendaki:*
(Duration of Stay):

Tempat Penginapan:*
(Accommodation Address):

Nota: Hotel penginapan hendaklah ditempah sebelum tarikh ketibaan di Negara Brunei Darussalam. Penjamin/Pemohon hendaklah menghubungi hotel-hotel bagi mendapatkan kadar terkini dan membuat tempahan penginapan. Adalah dinasihatkan untuk membuat tempahan selama 6 hari minima. Tempoh pengasingan diri adalah diantara 2 ke 14 hari tertakluk kepada penilaian risiko kesihatan setelah tiba di Negara Brunei Darussalam.
Note: Hotel accommodation must be reserved before intended date of arrival in Brunei Darussalam. Sponsor/Applicant are required to contact hotels directly to seek information on respective prevailing hotel rates and to proceed with making reservations. It is advised to make a booking of a minimum 6 days. Period of isolation may be 2-14 days depending on health risk assessment upon arrival.

Laluan Masuk:*
Route of Entry:

Tempat Terakhir Berlepas:*
(Last Place of Embarkation):

Tarikh Masuk Ke Brunei Darussalam:*
(Date of Entry to Brunei Darussalam):

Tarikh Pulang Ke Negara Asal:*
(Date of Return to Origin Country):

Jenis Pengangkutan yang digunakan:*
(Mode of Transport):

Nombor Pengangkutan yang digunakan (seperti no. penerbangan):*
(Inbound Flight Route / Sea Vessel Number / Vehicle Registration Number):

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.).