You are on page 1of 2

AK/ITU/B003/08

KOLEJ POLY-TECH MARA BATU PAHAT

Tingkat 3, Bangunan Tabung Haji


Jalan Timah Sari
83000 Batu Pahat
Johor Darul Takzim
Tel: 07-434 5685 Fax: 07-434 5697

INDUSTRIAL TRAINING REGISTRATION FORM

This is to confirm that this student has reported for duty in our organization
on 10 January 2011.

STUDENT
I.D. No: ___________________________________________________
Name :____________________________________________________
Name & Address :____________________________________________
of the organization ___________________________________________
___________________________________________________

SUPERVISOR
Name :____________________________________________________
Designation :_______________________________________________
Contact No. :_______________________________________________
Email :____________________________________________________
Signature :_________________________________________________

The completed form must be submitted to the address below:


Coordinator
Industrial Training Unit
Kolej Poly-Tech MARA Batu Pahat
Tingkat 3, Bangunan Tabung Haji
Jalan Timah Sari
83000 Batu Pahat
Johor Darul Takzim
Tel : 07-434 5685
Fax: 07-434 5697

Email : < ind_training>@kptm.edu.my

If this form is not returned within the stipulated date, it will be assumed that the student is
not registered and did n ot report for duty. Hence, no evaluation will be made on the student.

You might also like