The 24th JAPANESE SPEECH CONTEST

in BRUNEI DARUSSALAM

APPLICATION FORM
PERSONAL INFORMATION OF APPLICANT / Please paste your
photo here.
(Passport size)
Name in BlockLetters
Gender / Male  Female / Age
Nationality / I.C. No.
Local Address
E-mail Address
Telephone No. / Home: Office: Hand Phone:
Social Status /  Student  Civil Servant  Private Firm  Retired  Others ( )
Have you taken part in the Ship for Southeast Asian Youth Program (SSEAYP)? / No  Yes (Year: )

SPEECH INFORMATION

Speech Title / In Japanese: / Category /  Beginners
In English: /  Advanced /  Open

PERSONAL HISTORY OF STUDYING JAPANESE LANGUAGE

NO. / School / Study Method / Period (MM/YY – MM/YY) / Total (Year & Month)
EXAMPLE: Personal Lesson (by Mrs Naomi Brown) / Jan 2004May 2005 / 1 Yr6Months
1
2
Should you need more space use the table provided at the back of this form. / TOTAL

PERSONAL HISTORY OF STAYING IN JAPAN

NO. / Purpose / Period (MM/YY – MM/YY) / Total (Year & Month)
EXAMPLE: Study (SakuraUniversity) / Jun 2005Mar 2008 / 2 yrs & 6 months
1
2
Should you need more space use the table provided at the back of this form. / TOTAL

PERSONAL HISTORY OF PARTICIPATING JAPANESE SPEECH CONTESTS

NO. / Name of Contest / When (MM/YY) / Prize Awarded
1
2

Should you need more space use the table provided at the back of this form.

I hereby agree to the conditions stated in the rules and regulations of the contest and declare that theabove statements are true and correct to the best of my knowledge and belief.

Date / Signature

PERSONAL HISTORY OF STUDYING JAPANESE LANGUAGE (Continued)

NO. / School / Study Method / Period (MM/YY – MM/YY) / Total (Year & Month)
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8
TOTAL

PERSONAL HISTORY OF STAYING IN JAPAN (Continued)

NO. / Purpose / Period (MM/YY – MM/YY) / Total (Year & Month)
3
4
5
6
7
8
TOTAL

PERSONAL HISTORY OF PARTICIPATING JAPANESE SPEECH CONTESTS (Continued)

NO. / Name of Contest / When (MM/YY) / Prize Awarded
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