REFERRAL CODE

Please obtain your referral code from your Counsellor:

COURSE INFO

Choose your Course:—Please choose an option—Executive Diploma in Business Management (2 years)

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:
Office Address:
Telephone No.:
Fax No.:
Main Duty:
Previous Working Experience:

ACADEMIC BACKGROUND

Instution / School:
From Year:
To Year:
Qualification: SKMSPMPMRUPSR

REFEREE

Referee's Name:
Referee's Address:
Referee's Occupation:
Referee's Telephone:
Referee's Email:

PAYMENT INFORMATION

PTPTNSelf FundingEPF Withdrawal

PAYMENT RECEIPT

DECLARATION

I have downloaded and reviewed the Students Undertaking 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.