Choose your course: —Please choose an option—Prof. Diploma in Management (12 Months)Prof. Diploma in Engineering Management (12 Months)Prof. Diploma in Plantation Management (12 Months)Prof. Diploma in Occupational Safety & Health (12 Months)Prof. Masters in Business Administration (12 Months)

PERSONAL PARTICULARS

Full Name:
Contact No.:
Identification No.:
Gender: —Please choose an option—MaleFemale
Date of Birth:
Marital Status: —Please choose an option—SingleMarriedDivorced
Email Address:
Citizenship: —Please choose an option—MalaysianNon-Malaysian
Full Address:

JOB INFORMATION

Employer Name:
Position:
Starting Date:
Department:
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Fax No.:
Main Duty:
Previous Working Experience:

ACADEMIC BACKGROUND

REFEREE

Referee's Name:
Referee's Address:
Referee's Occupation:
Referee's Telephone:
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PAYMENT INFORMATION

Self FundingCompany FundingBank LoanEPF Withdrawal

PAYMENT RECEIPT

ADDITIONAL INFO

Name of Our Representative: —Please choose an option—Muhd HanzMs. RanjeetaMr. Hasifi HaziqMs. SuhaizaMs. AinMr. EdwinMs. Cynthia

DECLARATION

I hereby certify that the information that I have given in this application form is correct.
 

I agree to the condition that the University has the right to reject this application, to withdraw the offer of admission or to terminate my study if any information given is found to be incorrect. I also observe and ensure payment of all fees and other liabilities.