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B/HEA/URA/207
1. Borang ini hendaklah diisi dengan lengkap berdasarkan surat tawaran.
(Fill up the form completely based on offer letter)
2. Sila sertakan 1 keping gambar berukuran passport.
(To attached 1 photo passport size)
TARAF PENCALONAN
( Candidature )
:
SEPENUH MASA
( Full-Time )
SEPARUH MASA
( Part-Time )
k
NAMA
( Name )
k
NO. K/P / PASPORT
( I/C No. / Passport No. ) k
NO. MATRIK
( Matric No. ) k
NO. TELEFON BIMBIT
( Mobile Phone No. ) k
PROGRAM
( Programme )
FAKULTI
( Faculty )
SESI KEMASUKAN
( Intake Session )
ADAKAH ANDA PERNAH MEMBUAT PERTUKARAN PROGRAM?
( Have you made any program changes? )
YA
(Yes)
TIDAK
(No)
Dengan ini disahkan bahawa butir- butir peribadi dan maklumat yang diisi adalah benar dan lengkap
( I hereby declare that all information stated in this form is true and complete )
UNTUK KEGUNAAN PEJABAT ICT.
TANDATANGAN PEMOHON
(Applicant Signature)
____________________
TARIKH (Date) :
____/____/____
UNIVERSITI INDUSTRI SELANGOR
No. Pendaftaran : KP / JPS / DFT / US / B06
No. Siri : PICT/0000
BORANG PERMOHONAN KAD PELAJAR
( STUDENT CARD APPLICATION FORM )
MAKLUMAT PERIBADI (PERSONAL PARTICULARS)
Gambar
(Photo)
Catatan :
18

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Borang Kad Pelaja Ruda

  • 1. B/HEA/URA/207 1. Borang ini hendaklah diisi dengan lengkap berdasarkan surat tawaran. (Fill up the form completely based on offer letter) 2. Sila sertakan 1 keping gambar berukuran passport. (To attached 1 photo passport size) TARAF PENCALONAN ( Candidature ) : SEPENUH MASA ( Full-Time ) SEPARUH MASA ( Part-Time ) k NAMA ( Name ) k NO. K/P / PASPORT ( I/C No. / Passport No. ) k NO. MATRIK ( Matric No. ) k NO. TELEFON BIMBIT ( Mobile Phone No. ) k PROGRAM ( Programme ) FAKULTI ( Faculty ) SESI KEMASUKAN ( Intake Session ) ADAKAH ANDA PERNAH MEMBUAT PERTUKARAN PROGRAM? ( Have you made any program changes? ) YA (Yes) TIDAK (No) Dengan ini disahkan bahawa butir- butir peribadi dan maklumat yang diisi adalah benar dan lengkap ( I hereby declare that all information stated in this form is true and complete ) UNTUK KEGUNAAN PEJABAT ICT. TANDATANGAN PEMOHON (Applicant Signature) ____________________ TARIKH (Date) : ____/____/____ UNIVERSITI INDUSTRI SELANGOR No. Pendaftaran : KP / JPS / DFT / US / B06 No. Siri : PICT/0000 BORANG PERMOHONAN KAD PELAJAR ( STUDENT CARD APPLICATION FORM ) MAKLUMAT PERIBADI (PERSONAL PARTICULARS) Gambar (Photo) Catatan : 18