Borang Kad Pelaja Ruda

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Borang Kad Pelaja Ruda

  1. 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

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