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Please complete all sections on this form and read the policy overleaf before submitting this form to Registrars Office.
SECTION A: PERSONAL AND ACADEMIC PARTICULARS (Please the appropriate box)
Programme: Intake:
SECTION B: REASON(S) FOR WITHDRAWAL / COMPLETION OF STUDIES (Please the appropriate box)
Obtained offer from other University Completion of Studies Transfer to other University
Remarks:
Remarks:
Lost library item(s): Yes No Library fines: Yes No Student has overdue item(s): Yes No
If Yes, please state the total amount due + processing fees (RM10): _________________________________________________
Remarks:
SECTION F: CLEARANCE FROM STUDENT AFFAIRS MANAGER - HOSTEL (Please the appropriate box)
(please return the keys to the room and unit together with the hostel clearance form)
Remarks:
Remarks:
SECTION H: CLEARANCE FROM REGISTRAR & ADMISSION (Please the appropriate box)
Remarks:
Please specify the type of payment for refund: Refund of Fees Refund of Deposits
Please specify the payment option for refund: Bank Draft (Overseas bank) Crossed Cheque (Local bank)
Please specify the payee for refund: Self
Father Mother Guardian
Name:
MyKad/Passport No.:
Please specify the collection method for refund: Collect personally or by the payee
Post by mail to the address below
Address :
State: Country:
Collect on behalf (Note: A letter of authorisation is required)
SECTION J: FINANCE
Personal Bond RM
Tuition Fee RM
Hostel Deposit RM
Sub Total RM
Sub Total RM
1. If students wish to withdraw from a program, they must submit a written application
(Notification of Withdrawal from the University form) obtainable from the Admissions
Office to the Dean. A request for withdrawal from a program will be treated as a
request for withdrawal from all subjects.
3. The official date of withdrawal is the date on which their withdrawal form is received by
MIU even if students have stopped attending lectures earlier.
4. Students are liable to pay all fees due to MIU for the new semester even if they do not
attend classes without notifying MIU of their withdrawal. Students will be withdrawn
from MIU.
5. All books and other facilities borrowed from MIU must be returned. MIU entrusts
students with this responsibility. Their failure to do so will result in withholding of all
refundable deposits including the Caution Fee.
I hereby declare that all information provided by me in this form is accurate and I agree to the above terms and
conditions.
Date : ______________________________________________