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KOLEJ UNITI

UNITI EDUCATION GROUP


Index No :____________
Batch No :____________


INTERNATIONAL STUDENTS PERSONAL DATA /
ADMISSION APPLICATION FORM

Course Intake


( PLEASE FILL IN BLOCK LETTERS )


A. PERSONAL DATA

Title : Mr. Mrs. Ms. Others :_____________


Name :
Passports
( Please write as per passport ) Sizes
Photograph
Passport Number :








Date Of Birth :____________________ Place Of Birth :____________________ Nationality:_______________________
( dd mm yyyy)

Marital Status:_________________________
Race:________________________ Religion:_________________________


Origin Country Address :_________________________________________________________________________________

Postal code:_________________________ State:_________________________ Country:_________________________

Tel No:__________________ Fax:_________________ Mobile No:____________________ Email:___________________

Correspondent/ Current Address__________________________________________________________________________
( In Malaysia )


B. GUARDIANS DETAIL / EMERGENCY CONTACT

1st Contact 2nd Contact
Names
Relationship's

Complete Address

Tel. No
Mobile No
Email

C. LATEST QUALIFICATIONS

University / Collage / Institute / School Name Of Award Year of Passing Award /Grade







D. MEDICAL HISTORY
E. FINANCIAL SUPPORT
F. DOCUMENTS SUBMISSION CHECKLIST
G. DECLARATION






Major illness / Disability / Handicap :________________________________________________________________________
Medication : ________________________________________________________________________________________
Blood Group : _________________________________ Blood Donor No : ______________________________________


Self / Family Employer Scholarship Loans ________________________
(Please provide supporting documents)


8 Passport size colored recent photographs
Photocopy of all pages of Passport including empty pages
Photocopy of all related Supporting Educational Credentials (Certified by Origin Council/Notaries Office/Authorized
Officials)
1. O Level / A Level / Certificate/ Diploma / Degree Certificate
2. School Leaving Certificates
3. O Level / A Level / Certificate/ Diploma / Degree transcripts
4. Proof of Professional Bodies Membership (if any)
Admission processing fee (Non-refundable)
If financed by scholarship / government / study loan, please provide evidence

Additional Documents for International Student

Health Examination Forms
Insurance Form
NOC letter from students native countrys authority (for selected countries by Immigration Department of Malaysia
Please Contact your admission Counselor at KUSB)



I declare that to the best of my knowledge the information on this form is correct & complete. I understand that if I provide
incorrect information this may result in my ineligibility for admission & or enrolment. I also recognize that it is my
responsibility to provide all necessary supporting documentary evidence. I recognized that all information provided,
results as a property of the College. I authorize the College/ its representative to obtain/release official records with
respect to my application to/from the appropriate education institutions & other related bodies/ organizations/ activities/
campaigns.



Applicants Signature Date : DD/MM/YYYY
This declaration must be signed by the applicant / student