EXAMINATIONS SECTION

COLLECTION OF SCROLL BY REPRESENTATIVE

PART A (Must be completed)

Graduand’s Full Name : __________________________________________________

(Please use CAPITAL LETTERS)

Mykad/Passport number : __________________________________________________

Academy/Faculty/Centre : __________________________________________________
Degree : __________________________________________________
Permanent Address : __________________________________________________
__________________________________________________

PART B
(to be completed only if collection of scroll and transcript is by GRADUAND’S REPRESENTATIVE)

Name of Representative : ____________________________________________

(Please use CAPITAL LETTERS)

Representative’s Mykad/Passport number : ____________________________________________

Relationship with Graduand : ____________________________________________

ATTACHED are the following documents:

Original Matric Card Copy of Graduand’s Mykad/Passport

Mykad/Passport of Representative
(to be presented at counter)

I hereby accept that this particular transaction of scroll-collection is subject to the regulations for
scroll-collection by a representative and I shall not present any claim if the scroll is damaged or
misplaced after it has been collected by the named representative.

_________________________________ _______________________________
(date) (graduand’s signature)