ENROLMENT TO UNDERGRADUATE PROGRAMS

PREVIEW DETAILS
PERSONAL DETAILS
Name
NUR ASYIRAH HIDAYAH BINTI MAZLAN.
Postal Address NO.28, KAMPUNG RENGAS, 16300 BACHOK, KELANTAN.
Postcode
State
Country

16300 BACHOK
KELANTAN
MALAYSIA

Identification Card (I.C) Details

New NRIC

930529035790

Date of Birth
Nationality
Race

29-5-1993
MALAYSIAN

Gender

FEMALE

Marital Status

SINGLE

Religion ISLAM

Telephone Information (At least 1 phone number must be

entered)
Home
Handphone
Email

0111999081
syiera_gurl93@yahoo.com

Permanent
Address

NO.28, KAMPUNG RENGAS, 16300 BACHOK, KELANTAN.

Postcode
State
Country

16300 BACHOK
KELANTAN
MALAYSIA

Particular of Parents (Mother/Father/Guardian/Emergency

Contact)

Name
MAZLAN BIN AB. GHANI.
Correspondence
NO.28, KAMPUNG RENGAS, 16300 BACHOK, KELANTAN.
Address
Postcode
State
Country

16300 BACHOK
KELANTAN
MALAYSIA

Phone Number 0133713504

Office Number
Fax Number
EDUCATION BACKGROUND
(The University reserves the right to withdraw the OFFER if any information given is found to be
false or misleading or if entry requirements are not met)

SPM / SPMV / O-Level

Certificate Type
SPM
Year
2010
Stream(science/art) SCIENCE
School
Sekolah Menengah
Institution Name
SMK METHODIST (ACS), PARIT BUNTAR.
Grade
Select

No

Subject

1
2
3

Bahasa Melayu
1A / A
Matematik
4B / B
Bahasa Inggeris
8E / E
Pendidikan Islam/Pend Syariah
Islamiah/Tasawwur Islam/Pend Al- 4B / B
Quran & As-Sunnah
Sejarah
7D / D
Biologi
8E / E
Matematik Tambahan
9G / G
Prinsip Akaun
7D / D
Kimia
9G / G

4
5
6
7
8
9

Grade

STPM/STAM
Certificate Type
STPM
Year
2012
Stream(science/art) ART
School
Sekolah Menengah
SEKOLAH MENENGAH KEBANGSAAN BACHOK,
Institution Name
KELANTAN.
Grade
2.33

No

Subject

Grade

1
2
3

Pengajian Am
Bahasa Melayu
Sejarah

C+
BC

4
5

Geografi
Pengajian Perniagaan

C+
C

MUET
MUET YEAR
MUET BAND

2012
2

HEALTH DECLARATIONS
HAVE YOU HAD ANY HEALTH PROBLEMS?
NO
If Yes, Please Specify :
HAVE YOU COLOUR BLIND SYMTOMS (CONFIRMED BY DOCTOR)?
NO
HAVE YOU HAD ANY DISABILITY?
NO
If Yes, Please Specify :

QUESTIONNAIRES
HOW DO YOU KNOW ABOUT UNISEL?
FAMILY/FRIENDS
REASON FOR CHOOSING UNISEL?
FEES
DECLARATION

I certify that the information that I have given in this aplication 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 so to terminate my study if any
information given is found to be incorrect. I also undertake to observe and
ensure payment of all fees and other liabilities are made on time

Name

NUR ASYIRAH HIDAYAH BINTI MAZLAN.

Date

2013-04-24