Académique Documents
Professionnel Documents
Culture Documents
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Photograph
Instructions:
A.
PROGRAMME APPLIED
First Choice
Second Choice
B.
PERSONAL DETAILS
Passport No.:
Country/state of origin
Age:
Gender:
Male:
Date of Expiry:
Marital Status:
Single:
Married:
Postal Address:
Street:
City/State:
Telephone No:
Female:
Country:
Fax No:
E-mail Address:
C.
ACADEMIC QUALIFICATIONS
Please list below schools attended and qualifications/diplomas/certificate obtain (starting from secondary education)
(Please attach certified copies of the original certificates/documents and transcript)
Name of School
(Location/State/Country)
D.
Date of Entry
(month & year)
Date of Leaving
(month & year)
Certificate
Obtained
COURSE
TOEFL
SCORE/POINT/BAND
IELTS
OTHERS (Specify)
E.
Score/Grade/
CGPA/Division
FINANCIAL RESOURCES
Sponsorship
If self-funding please provide letter indicating your ability to finance your education
If sponsored, please provide name and address of sponsor:
Name of sponsor:
Address of sponsor:
Postcode:
Country:
Relationship:
Telephone No:
Occupation:
F.
No.
Games/Societies
G.
Position Held
Year
It is compulsory to obtain a V&R visa to enter Malaysia from the Malaysian Embassy / Consulate / High Commission in your
country before entering Malaysia. UKM will process the V&R for student to enable student to enter Malaysia. UKM will inform
the student the application status dan V&R through the Malaysian Embassy / Consulate / High Commission in your country.
Please mention the nearest Malaysian Embassy / Consulate / High Commission address;
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
H.
DECLARATION
I declare that all information and documents provided are true and complete. I acknowledge that Universiti Kebangsaan Malaysia
may reject my application if the information and documents provided are found to be untrue or incomplete.
Signature: ___________________________________
Date: _________________
LAMPIRAN A
BTK 100
KERAJAAN MALAYSIA
(GOVERNMENT OF MALAYSIA)
BORANG MAKLUMAT PERIBADI PELAJAR NEGARA CHINA
(PERSONAL PARTICULARS FORM FOR REPUBLIC OF CHINA STUDENTS)
2.
3.
b)
4.
5.
6.
Kewarganegaraan : _________________________________________________________________
(Citizenship)
7.
Alamat tetap :
_____________________________________________________________________
(Permanent address)
____________________________________________________________________
____________________________________________________________________
8.
9.
10.
Tujuan lawatan :
(Purpose of visit)
11.
12.
_________________________________________________________
________________________________________________
_____________________________________________
13.
____________
Pasport (Passport) /____________/
b)
2.
Nombor : ______________________________________
(Number)
3.
4.
5.
Tempoh sah
: _________________________________________________________
(period of validity)
_____________________________________________
: ___________________________________________________
2.
(b)
3.
__________________________________________
BAHAGIAN
__________________________________________
PEGURUSAN
AKADEMIK
__________________________________________
UKM
4.
__________________________________________
5.
____________________________________________________________
IPTA-B2
___________________________
Tarikh (Date)
____________________________
Tandatangan pemohon
(Signature of applicant)