BORANG PENJAMIN KEWANGAN

FINANCIAL GUARANTOR FORM

(PPS 004)

NAMA PEMOHON
(APPLICANT’S NAME)

NO KAD PENGENALAN( I/C )

NO PASPORT( PASSPORT NO)

(UNTUK PEMOHON LUAR NEGARA SAHAJA(FOR INTERNATIONAL APPLICANTS ONLY)

(DIISI OLEH PENJAMIN KEWANGAN SENDIRI ( TO BE FILLED IN BY FINANCIAL GUARANTOR)

NAMA PENJAMIN
(GUARANTOR’S NAME)

NO KAD PENGENALAN(1/C)
NO PASSPORT( PASSPORT NO )

ALAMAT
(ADDRESS)

NO TELEFON PEJABAT
(OFFICE TELEPHONE NO)

NO TELEFON RUMAH
(HOUSE TELEPHONE NO)

PEKERJAAN
(OCCUPATION)

PENDAPATAN SEBULAN
( INCOME PER MONTH)

PENGAKUAN PENJAMIN ( DECLARATION BY THE FINANCIAL GUARANTOR )

Saya mengaku akan menjelaskan segala bayaran pengajian penama tersebut di UKM sekiranya penama tidak
mampu/gagal menjelaskanya.
( I declare I will settle all the outstanding payments due to UKM for the above named for his/her study at UKM in the
event that he/she is unable to do so)

TANDATANGAN
( SIGNATURE )

TARIKH
( DATE )