The 1st ASEAN-Korea Academic Essay Contest

APPLICATION FORM

Family Name
(In English)
Date of Birth
Nationality
E-mail
Current Address

Full Given
Name
(In English)
Gender
Phone No.

Syamsul Bahri Hasmah Sakka

Syamsul Bahri Hasmah

Sakka

December 12, 1995

Male
Indonesia
085242320686
syamsulbahrihs798@gmail.co
Mobile No.
m
Jl.Traktor II No.2 Komp. PU Mallengkeri Makassar Sulawesi Selatan
Indonesia

Theme
Educational
Background
(Undergraduate)
Educational
Background
(Graduate)

University :
Country: Indonesia
Major: Year 2014
University: State University of Makassar
Country: Indonesian
Major : Biology Department Year: 2014

I hereby declare that all information provided herein is true and correct.
Date:

Name:

(signature)

CONSENT FORM
1. Collection of your personal information
In due consideration of Article 15 of the Personal Information Protection Act of the Republic
of Korea, the ASEAN-Korea Centre (hereinafter referred to as AKC) hereby requests your
consent to collect and/or use your personal information.
Type of information to be collected, collection method, purpose of collection/use, and the
period of retention/use are as follows:
A. Type of Information Collected and Collection Method
- Application-related information: (English/Korean) name, date of birth, gender, address,
nationality, email address, mobile number, name of school, major, country of school, date
of (expected) graduation.
- Collection Methods: documents submission
B. Purpose of Collection/Use: application process
C. Period of Retention/Use: prompt destruction 3 years after date of collection
D. You have the right to withhold consent to the collection and/or use of your personal
information. If you withhold consent, you may not proceed in the application process.
2. Privacy and Intellectual Property
AKC reserves the right to utilize all data submitted by individuals to AKC without
limitations.
3. Code of Conduct
Applicants hereby certify that upon completion of the application process, all information
submitted is truthful and accurate. Participants understand that falsification of any
information provided will disqualify him or her from participation in the 1 st ASEAN-Korea
Academic Essay Contest (hereinafter referred to as the Contest), and falsification of
information or impersonation will result in legal actions.
Participants agree that all materials produced for the Contest will be original work.
Plagiarism will not be tolerated by AKC, and should AKC discover instances of plagiarism,
the individual will be disqualified from the Contest.

I hereby consent to the terms and conditions as specified above. (Yes, No)
Date:

Name:

(signature or seal)

Accepted and Acknowledged by the ASEAN-Korea Centre