c/o Custommedia Sdn Bhd,
A-6-1 Mines Waterfront Business Park,
The Mines Resort City,
43300 Seri Kembangan, Selangor, MALAYSIA.
REGISTRATION FOR ISTQB CERTIFIED TESTER FOUNDATION LEVEL EXAMINATION
Instructions:· Please complete the form below. Please print legibly.
· Remit the Foundation Level examination fee of RM375.00 together with this application. Payments may be made in cash or cheque (payable to “Custommedia Sdn Bhd”.). For other arrangements, please contact the MSTB Secretariat at +603-89433480
Personal Information
Full Name (as per IC / :/ passport)
Nationality / :
IC Number (New) / : / - / -
(Malaysian only)
Passport No. (if applicable) / :
Gender / : / M / / / F
Company Name / :
Job title / :
Preferred Address* / :
:
City
/ :Postcode / : / Country
Telephone No (Work) / : / + / -
Telephone No (Home) / : / + / -
Telephone No (Mobile) / : / + / -
Preferred Email** / :
Examination Information
Exam type (please Ö) / : / First time / Re-takeRequested Exam / :
Location/Center
Requested Exam / : / / / /
Date /
Day
/Month
/Year
Terms and conditions:· * = The address where all correspondences and certificates will be sent to.
· ** = Exam results notification will be sent to this email.
· Candidates will be notified of exam results within two (2) weeks of examination date.
· Certificates will be delivered to successful candidates within four (4) weeks for examination date.
· Certificates will be issued only after clearance of payment.
For MSTB Secretariat Use Only
Confirmed Exam Date / : / / / /Day
/Month
/Year
Exam Location/Center / :Candidate Reg. No / : / /
Series No. / Year