CERIA POPSTAR ENTRY FORM
BORANG PENYERTAAN PESERTA CERIA POPSTAR
Please include IC / birth certificate for each group member and group photo sized 4R
Sila lampirkan bersama Kad Pengenalan / Surat Beranak bagi setiap ahli kumpulan dan gambar kumpulan berukuran 4R
Name / GROUP NAME
Nama / Nama Kumpulan
SONG NAME & ORIGINAL SINGER
NAMA LAGU& PENYANYI ASAL:
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GROUP LEADER INFORMATION |
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Maklumat Ketua Kumpulan |
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NAME |
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Nama |
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MAILING ADDRESS
Alamat Surat
Menyurat
IC NUMBER |
DATE OF |
PLACE OF BIRTH |
Nombor |
BIRTH |
Tempat Lahir |
Kad Pengenalan |
Tarikh Lahir |
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PHONE NUMBER |
PHONE |
PHONE NUMBER |
(HOME) |
NUMBER |
(MOTHER/FATHER/ |
Tel No (rumah) |
(MOBILE) |
GUARDIAN) |
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Tel No |
Tel No |
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(mobile) |
(Ibu/Bapa/Penjaga) |
GENDER |
RACE |
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Jantina |
Keturunan |
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SPOKEN
LANGUAGE
Bahasa Pertuturan
eMAIL Email
SCHOOL NAME
Nama Sekolah
GROUP MEMBERS
AHLI KUMPULAN
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NAMA |
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IC NUMBER |
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DATE OF BIRTH |
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NO KAD PENGENALAN |
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TARIKH LAHIR |
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PHONE NUMBER |
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TEL NO (MOBILE) |
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GENDER |
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RACE |
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JANTINA |
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BANGSA |
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SPOKEN LANGUAGE |
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EMAIL |
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BAHASA PERTUTURAN |
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EMAIL |
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FAMILY INFORMATION (AGED 18 AND ABOVE, IF ANY EMERGENCY CASE)
MAKLUMAT AHLI KERLUARGA (BERUASIA 18 TAHUN KE ATAS, JIKA BERLAKU KECEMASAN)
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INFORMATION 1 |
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INFORMATION 2 |
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MAKLUMAT 1 |
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MAKLUMAT 2 |
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NAME |
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NAME |
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NAMA |
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NAMA |
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PHONE NUMBER |
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NO TEL |
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NO TEL |
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NAME |
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NAMA |
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IC NUMBER |
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DATE OF BIRTH |
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NO KAD PENGENALAN |
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TARIKH LAHIR |
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PHONE NUMBER |
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PHONE NUMBER |
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(HOME) |
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TEL NO (MOBILE) |
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TEL NO (RUMAH) |
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GENDER |
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RACE |
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JANTINA |
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BANGSA |
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SPOKEN LANGUAGE |
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EMAIL |
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BAHASA PERTUTURAN |
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EMAIL |
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FAMILY INFORMATION (AGED 18 AND ABOVE, IF ANY EMERGENCY CASE)
MAKLUMAT AHLI KERLUARGA (BERUASIA 18 TAHUN KE ATAS, JIKA BERLAKU KECEMASAN)
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INFORMATION 1 |
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INFORMATION 2 |
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MAKLUMAT 1 |
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MAKLUMAT 2 |
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NAME |
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NAME |
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NAMA |
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NAMA |
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PHONE NUMBER |
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PHONE NUMBER |
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NO TEL |
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NO TEL |
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GROUP MEMBERS
AHLI KUMPULAN
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NAME |
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NAMA |
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IC NUMBER |
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DATE OF BIRTH |
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NO KAD PENGENALAN |
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TARIKH LAHIR |
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PHONE NUMBER |
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PHONE NUMBER |
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(HOME) |
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TEL NO (MOBILE) |
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TEL NO (RUMAH) |
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GENDER |
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RACE |
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JANTINA |
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BANGSA |
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SPOKEN LANGUAGE |
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EMAIL |
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BAHASA PERTUTURAN |
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EMAIL |
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FAMILY INFORMATION (AGED 18 AND ABOVE, IF ANY EMERGENCY CASE)
MAKLUMAT AHLI KERLUARGA (BERUASIA 18 TAHUN KE ATAS, JIKA BERLAKU KECEMASAN)
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INFORMATION 1 |
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INFORMATION 2 |
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MAKLUMAT 1 |
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MAKLUMAT 2 |
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NAME |
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NAME |
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NAMA |
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NAMA |
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PHONE NUMBER |
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PHONE NUMBER |
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NO TEL |
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NO TEL |
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5 |
NAME |
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NAMA |
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IC NUMBER |
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DATE OF BIRTH |
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NO KAD PENGENALAN |
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TARIKH LAHIR |
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PHONE NUMBER |
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PHONE NUMBER |
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(MOBILE) |
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(HOME) |
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TEL NO (MOBILE) |
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TEL NO (RUMAH) |
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GENDER |
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RACE |
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JANTINA |
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BANGSA |
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SPOKEN LANGUAGE |
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EMAIL |
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BAHASA PERTUTURAN |
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EMAIL |
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FAMILY INFORMATION (AGED 18 AND ABOVE, IF ANY EMERGENCY CASE)
MAKLUMAT AHLI KERLUARGA (BERUASIA 18 TAHUN KE ATAS, JIKA BERLAKU KECEMASAN)
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INFORMATION 1 |
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INFORMATION 2 |
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MAKLUMAT 1 |
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MAKLUMAT 2 |
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NAME |
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NAME |
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NAMA |
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NAMA |
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PHONE NUMBER |
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PHONE NUMBER |
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NO TEL |
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NO TEL |
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GROUP MEMBERS
AHLI KUMPULAN
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NAME |
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NAMA |
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IC NUMBER |
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DATE OF BIRTH |
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NO KAD PENGENALAN |
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TARIKH LAHIR |
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PHONE NUMBER |
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PHONE NUMBER |
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(MOBILE) |
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(HOME) |
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TEL NO (MOBILE) |
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TEL NO (RUMAH) |
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GENDER |
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RACE |
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JANTINA |
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BANGSA |
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SPOKEN LANGUAGE |
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EMAIL |
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BAHASA PERTUTURAN |
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EMAIL |
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FAMILY INFORMATION (AGED 18 AND ABOVE, IF ANY EMERGENCY CASE)
MAKLUMAT AHLI KERLUARGA (BERUASIA 18 TAHUN KE ATAS, JIKA BERLAKU KECEMASAN)
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INFORMATION 1 |
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INFORMATION 2 |
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MAKLUMAT 1 |
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MAKLUMAT 2 |
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NAME |
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NAME |
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NAMA |
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NAMA |
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PHONE NUMBER |
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PHONE NUMBER |
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NO TEL |
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NO TEL |
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7 |
NAME |
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NAMA |
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IC NUMBER |
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DATE OF BIRTH |
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NO KAD PENGENALAN |
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TARIKH LAHIR |
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PHONE NUMBER |
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PHONE NUMBER |
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(MOBILE) |
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(HOME) |
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TEL NO (MOBILE) |
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TEL NO (RUMAH) |
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GENDER |
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RACE |
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JANTINA |
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BANGSA |
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SPOKEN LANGUAGE |
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EMAIL |
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BAHASA PERTUTURAN |
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EMAIL |
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FAMILY INFORMATION (AGED 18 AND ABOVE, IF ANY EMERGENCY CASE)
MAKLUMAT AHLI KERLUARGA (BERUASIA 18 TAHUN KE ATAS, JIKA BERLAKU KECEMASAN)
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INFORMATION 1 |
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INFORMATION 2 |
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MAKLUMAT 1 |
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MAKLUMAT 2 |
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NAME |
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NAME |
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NAMA |
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NAMA |
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PHONE NUMBER |
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PHONE NUMBER |
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NO TEL |
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NO TEL |
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GROUP MEMBERS
AHLI KUMPULAN
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NAME |
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NAMA |
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IC NUMBER |
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DATE OF BIRTH |
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NO KAD PENGENALAN |
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TARIKH LAHIR |
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PHONE NUMBER |
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PHONE NUMBER |
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(MOBILE) |
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(HOME) |
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TEL NO (MOBILE) |
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TEL NO (RUMAH) |
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GENDER |
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RACE |
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JANTINA |
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BANGSA |
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SPOKEN LANGUAGE |
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EMAIL |
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BAHASA PERTUTURAN |
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EMAIL |
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FAMILY INFORMATION (AGED 18 AND ABOVE, IF ANY EMERGENCY CASE)
MAKLUMAT AHLI KERLUARGA (BERUASIA 18 TAHUN KE ATAS, JIKA BERLAKU KECEMASAN)
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INFORMATION 1 |
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INFORMATION 2 |
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MAKLUMAT 1 |
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MAKLUMAT 2 |
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NAME |
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NAME |
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NAMA |
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NAMA |
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PHONE NUMBER |
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PHONE NUMBER |
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NO TEL |
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NO TEL |
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9 |
NAME |
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NAMA |
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IC NUMBER |
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DATE OF BIRTH |
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NO KAD PENGENALAN |
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TARIKH LAHIR |
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PHONE NUMBER |
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PHONE NUMBER |
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(MOBILE) |
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(HOME) |
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TEL NO (MOBILE) |
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TEL NO (RUMAH) |
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GENDER |
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RACE |
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JANTINA |
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BANGSA |
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SPOKEN LANGUAGE |
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EMAIL |
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BAHASA PERTUTURAN |
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EMAIL |
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FAMILY INFORMATION (AGED 18 AND ABOVE, IF ANY EMERGENCY CASE)
MAKLUMAT AHLI KERLUARGA (BERUASIA 18 TAHUN KE ATAS, JIKA BERLAKU KECEMASAN)
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INFORMATION 1 |
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INFORMATION 2 |
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MAKLUMAT 1 |
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MAKLUMAT 2 |
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NAME |
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NAME |
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NAMA |
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NAMA |
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PHONE NUMBER |
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PHONE NUMBER |
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NO TEL |
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NO TEL |
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ORGANIZATION INFORMATION (IF ANY)
Maklumat Persatuan (jika ada)
ORGANIZATION NAME
Nama Persatuan
PRINCIPAL NAME
Nama Pengetua
PHONE NUMBER
No Tel
FAMILY INFORMATION (AGED 18 AND ABOVE, IF ANY EMERGENCY CASE)
Maklumat Ahli Keluarga (berusia 18 tahun ke atas, jika berlaku kecemasan)
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INFORMATION 1 |
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INFORMATION 2 |
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Maklumat 1 |
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Maklumat 2 |
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NAME |
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NAME |
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Nama |
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Nama |
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PHONE NUMBER |
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PHONE NUMBER |
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No tel |
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no tel |
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I/We confirm all the information above is true:-
Dengan ini saya/kami mengesahkan bahawa semua yang dinyatakan adalah benar seperti berikut:-
1.I/We have given permission from parent/guardian for this competition.
Saya/kami mengaku telah mendapat kebenaran dan pelepasan daripada ibu/bapa atau penjaga untuk menyertai pertandingan ini.
2.I/We confirm that all the information are correct and true and I/we will not intentionally forget or change the information or even giving the false information. If I/we notified that I/we are discharged from the competition/ or drop out from this competition or program and I/we acknowledge that ASTRO has the right to cancel my/our participation.
Saya/kami mengaku bahawa semua butir-butir, data-data peribadi dan maklumat di dalam ini adalah benar, tepat dan akan kekal benar, dan saya/kami tidak akan atau dengan sengaja lupa dan/atau memberi maklumat yang salah. Jika saya/kami diberi notifikasi bahawa saya/kami telah hilang kelayakan pada bila-bila masa atau semasa pertandingan, saya/kami akan menarik diri dari pertandingan dan/atau produksi rancangan ini dan saya/kami mengesahkan bahawa pihak ASTRO berhak membatalkan penyertaan saya/kami.
3.I/we do not be hold by any contract with any recording company/ organization or anyone which can stop me/us from this competition.
Saya/kami tidak terikat secara kontrak/perjanjian dengan mana-mana syarikat rakaman, pengurusan dan mana-mana syarikat atau orang-orang yang boleh menghalang saya/kami menyertai pertandingan ini.
4.My/Our Preant is not an ASTRO workers and do noy have any relationship with any ASTRO workers or any which allign with it.
Ibu bapa saya/kami adalah bukan kakitangan ASTRO dan tidak ada-apa pertalian atau hubungan dengan mana-mana kakitangan ASTRO atau mana-mana sekutu mereka.
5.I/we do not have any fault and do not have any problem including ‘juvana’ till this from date. State if any.
Saya/kami tidak disabitkan dengan mana-mana kesalahan juvana sehingga tarikh borang ini. Jika ada, sila nyatakan.
6.I/We have read and understand the rules and regulation regarding this competition including this program mechanism and I/we agree without any requirement or specification and agree to accept and follow all the rules, terms and condition.
Saya/kami telah membaca dan memahami peraturan-peraturan dan terma-terma dan syarat-syarat pertandingan ini termasuk mekanisma rancangan ini dan saya/kami dengan ini menerima tanpa syarat dan bersetuju untuk menerima dan mematuhi semua peraturan-peraturan, terma-terma dan syarat- syarat pertandingan (dan sebarang pembetulan dari pihak ASTRO, jika ada).
7.I agree with the Privacy Notice in relation to the Personal Data Protection Act 2010 as set out in Appendix E1 in this form.
Saya bersetuju dengan Notis Privasi sehubungan dengan Akta Perlindungan Data Peribadi 2010 seperti yang dilampirkan di Lampiran E1 di dalam ini.
Members’ signature:-
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Tandatangan ahli kumpulan:- |
Date/ Tarikh: ……………………………… |
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FULL NAME |
IC NUMBER/ BIRTH |
SIGNATURE |
NAMA PENUH |
CERTICICATION NUMBER |
TANDATANGAN |
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NO K/P atau |
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NO SURAT BERANAK |
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1 |
Participant: |
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Peserta: |
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Mother/Father/Guardian: |
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Ibu/Bapa/Penjaga: |
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2 |
Participant: |
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Peserta: |
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Mother/Father/Guardian: |
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Ibu/Bapa/Penjaga: |
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3Participant:
Peserta:
Mother/Father/Guardian:
Ibu/Bapa/Penjaga:
4Participant:
Peserta:
Mother/Father/Guardian:
Ibu/Bapa/Penjaga:
5Participant:
Peserta:
Mother/Father/Guardian:
Ibu/Bapa/Penjaga:
6Participant:
Peserta:
Mother/Father/Guardian:
Ibu/Bapa/Penjaga:
7Participant:
Peserta:
Mother/Father/Guardian:
Ibu/Bapa/Penjaga:
8Participant:
Peserta:
Mother/Father/Guardian:
Ibu/Bapa/Penjaga:
9Participant:
Peserta:
Mother/Father/Guardian:
Ibu/Bapa/Penjaga:
IMPORTANT:
PENTING:
If you below 18 years old, consent MUST be give to your parent or guardian.
Jika anda berumur 18 tahun ke bawah, borang ini HARUSLAH ditandatangani oleh ibu bapa atau penjaga.
PRIVACY NOTICE FURTHER TO PERSONAL DATA PROTECTION ACT 2010
You are informed that the personal data otherwise (collectively, "Personal Data") provided on the registration form or your application will be used and processed by Astro Productions Sdn Bhd ("APSB") for the following purposes: -
a)Consider your application to participate in the plan and / or competition conducted and / or published by APSB and to administer your participation in the program and / or competition;
b)To liaise with, and provide services to you;
c)For the processing of payment transactions;
d)Respond to your inquiries;
e)Perform internal activities;
f)To provide you with information about products and services APSB, related corporations and business partners;
g)Activities APSB otherwise legitimate business, and / or
h)The purposes as stated in the Terms and Conditions of Competition.
(Collectively, the “Purposes”)
Further, please note that if needed for any purposes stated above, your Personal Data may be shipped to locations outside Malaysia or disclosed to a related corporation, licensees, business partners and / or service providers, which may are in or outside Malaysia. Other than as disclosed here, the Personal Data you will not be transferred to any place outside Malaysia or disclosed to any third party.
To enable us to process your Personal Data, you consent required. If you do not give consent may be, we can not process your Personal Data for any purposes stated above and your application to participate in the plan and / or competition.
You may raise questions, complaints and request access to, and correction of, the Personal Data or limit the processing of your Personal Data by sending a request to the Personal Data Protection Officer APSB through registered post or email as indicated below:
Maling Address: Pegawai Perlindungan Data Peribadi
Astro Productions Sdn Bhd
Peti Surat 1033, 50710 Kuala Lumpur
Email Address: pdpo@astro.com.my
You acknowledge and warrant that you have obtained the consent of third parties (eg, family members) for which their personal data has you reveal in your application form to allow APSB participation process such personal data for the purposes specified. If you are under 18 years old, consent must be given by a parent / guardian on your behalf.
NOTIS PRIVASI SEHUBUNGAN AKTA PERLINDUNGAN DATA PERIBADI 2010
Anda dimaklumkan bahawa data peribadi dan maklumat selainnya (secara keseluruhan, “Data Peribadi”) yang diberikan di dalam borang pendaftaran atau permohonan anda bakal digunakan dan diproses oleh Astro Productions Sdn Bhd (“APSB”) bagi maksud-maksud berikut:-
a)Mempertimbangkan permohonan anda untuk menyertai rancangan dan/atau pertandingan yang dikelolakan dan/atau diterbitkan oleh APSB dan untuk mentadbirkan penyertaan anda di dalam rancangan dan/atau pertandingan tersebut;
b)Untuk berhubung dengan, dan memberi khidmat kepada, anda;
c)Untuk memproses transaksi-transaksi pembayaran;
d)Menjawab pertanyaan-pertanyaan anda;
e)Melaksanakan kegiatan-kegiatan dalaman;
f)Untuk memberi anda maklumat tentang produk-produk dan perkhidmatan-perkhidmatan APSB, perbadanan-perbadanan berkaitan dan rakan-rakan perniagaan; kegiatan-kegiatan perniagaan APSB selainnya yang sah; dan/atau maksud-maksud selainnya seperti yang termaktub di dalam Terma-Terma dan Syarat-Syarat Pertandingan.
(Secara keseluruhan, “Maksud-Maksud”)
Seterusnya, sila maklum bahawa sekiranya diperlukan bagi mana-mana Maksud-Maksud yang dinyatakan di atas, Data Peribadi anda mungkin dihantar ke lokasi-lokasi di luar Malaysia atau dizahirkan kepada perbadanan berkaitan, pemegang lesen, rakan perniagaan dan/atau pemberi khidmat, yang mungkin berada di dalam atau luar Malaysia. Selain dari yang dinyatakan di sini, Data Peribadi anda tidak akan, dengan sedarinya, dipindahkan ke mana-mana tempat di luar Malaysia atau dizahirkan ke mana-mana pihak ketiga.
Bagi membolehkan kami memproses Data Peribadi anda, persetujuan anda diperlukan. Sekiranya anda tidak memberi persetujuan berkenaan, kami tidak dapat memproses Data Peribadi anda bagi mana-mana Maksud- Maksud yang dinyatakan di atas dan permohonan anda untuk menyertai rancangan dan/atau pertandingan berkenaan tidak dapat kami pertimbangkan.
Anda boleh pada bila-bila masa selepas ini mengemukakan pertanyaan, aduan dan meminta akses kepada, dan pembetulan terhadap, Data Peribadi atau menghadkan pemprosesan Data Peribadi anda dengan menghantar permintaan berkenaan kepada Pegawai Perlindungan Data Peribadi APSB menerusi pos berdaftar atau emel seperti yang dinyatakan di bawah:
Alamat pos: |
Pegawai Perlindungan Data Peribadi |
|
Astro Productions Sdn Bhd |
|
Peti Surat 1033, 50710 Kuala Lumpur |
Alamat emel: |
pdpo@astro.com.my |
Anda mengakui dan menjamin bahawa anda telah mendapatkan persetujuan pihak-pihak ketiga (misalnya, ahli- ahli keluarga) yang mana data peribadi mereka telah anda zahirkan di dalam borang permohonan penyertaan untuk membenarkan APSB memproses data peribadi tersebut bagi Maksud-Maksud yang dinyatakan. Sekiranya anda berusia bawah 18 tahun, persetujuan perlu diberikan oleh ibu bapa / penjaga anda bagi pihak anda.
DECLARATION AND AGREEMENT
PENGAKUAN DAN PERSETUJUAN
I confirm that I have read, understand and agree to the terms of this Privacy Notice and agree that my personal data is processed as described above.
Saya mengesahkan bahawa saya telah membaca, memahami dan bersetuju dengan terma-terma Notis Privasi ini dan bersetuju agar data peribadi saya diproses seperti yang dinyatakan di atas.
………………………………………. |
…………………………………….……. |
Signature |
Full Name |
Tandatangan |
Nama penuh |
Date: |
IC Number: |
Tarikh: …………………………….…. |
No. K/P : ……………………………….. |
Do you give consent as a parent or guardian of an individual under 18 years old whose personal data will be processed as described above?
Adakah anda memberikan persetujuan sebagai ibu bapa atau penjaga seorang individu bawah 18 tahun yang mana data peribadinya bakal diproses seperti yang dinyatakan di atas?
If yes, please complete the details below:
Jika ya, sila lengkapkan butiran di bawah:
Signature
Tandatangan: …………………………………………………………………………
Full Name Mother/Father/Guardian
Nama penuh ibu / bapa / penjaga: …………………………………………..
IC Number
No K/P: …………..…………………………………………………………….