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WITHDRAWAL FORM

Student Details
Students Name

:__________________________________________________________

I/C No./ Passport No.

:__________________________________________________________

Student ID Number

:__________________________________________________________

Telephone No.

:___________________________E-mail__________________________

Programme

:__________________________________________Semester:________

I am applying to withdraw from my studies at SEGi University College due to the following
reason/s:
______________________________________________________________________________
______________________________________________________________________________

------------------------Students Signature

---------------Date

Approved by:
Head of Department :________________________________________ Date:_______________
Remarks: ______________________________________________________________________
Deputy Vice-Chancellor
(Academic Affairs / Student Affairs)_____________________________ Date:_______________
Remarks: ______________________________________________________________________

Attended by (applicable to international students only)


International Office:_________________________________________Date:________________
Remarks:______________________________________________________________________
Updated in EMS system by:
Bursary :___________________________________________________ Date:_______________
Registry:___________________________________________________ Date:_______________
Withdrawal Letter issued by Registry on _______________
Updated: 27/6/ 2011