LI Placement Form (B) 2011/2012

UNIVERSITI MALAYSIA SARAWAK

94300 KOTA SAMARAHAN SARAWAK

FACULTY OF ENGINEERING
Industrial Training Placement Form
To be completed by the company (Once completed please send it by post and fax it to +6082 583410) Name of Organization Contact Person Name Nature of Business Address Contact Office Tel Fax e-mail Area/State:

Application Status Reason if decline: List of Expected Task(s) for the student

Accepted

Decline

Signature / Company Stamp

Date

Student Details (To be completed by student) Name of SITI MARLINA BINTI AHMAD MAKASAR Matric No. 28252 Student Current 1777,Lorong 5B, Temenggong Haji Gobil, Semariang Baru Fasa 3, 93050, Kuching Sarawak Address Home 1777,Lorong 5B, Temenggong Haji Gobil, Semariang Baru Fasa 3, 93050, Kuching Sarawak Address I/C No.: 910815135196 Programme: MECHANICAL AND MANUFACTURING ENGINEERING Contact Mobile No. 0149507314 Home e-mail marlinasiti93@gmail.com

LI Placement Form (B) 2011/2012

To be completed by the Industrial Training Coordinator

Comments:

Approved by Date

: :

Signature