Appendix V

Revision No. : 02
Effective Date: 01/12/2013
COMPANY REPLY FORM
(Kindly complete the form and return to IIUM)

Company/ Firm
Your Ref:

Our Ref: IIUM/304/C/13/13/1

Date :
Sector: Government/Semi-Government/Private (Please
circle)
Category of industry: (Eg: Oil &
Deputy Dean (Academic Affairs)
Kulliyah of Engineering, IIUM
Jalan Gombak, 53100, Kuala Lumpur
Phone: +603-61965729 / +603-61964406 Fax: +603-61964466
Email: (1) ihilmy@iium.edu.my (2) mdzamri@iium.edu.my

Dear Sir,

ENGINEERING INDUSTRIAL TRAINING FOR IIUM STUDENT

(Period: 06 June 2016 until 26 August 2016)

Pertaining to the above matter, we agree/do not agree* to accept the following student to
undergo Internship Training at our company/ firm.

Name :
Matric No. :
Majoring Field :

2. The student will be placed at : _______________________________________

(Address for reporting if different from above)
_______________________________________

_______________________________________

3. The student will be given (please tick ():

YES NO If YES
Subsistence monthly allowance RM:
Accommodation
Daily Transportation
Engagement on Project during Name of Project:
training

4. Please reply within _______ days from the date of this Reply Form.

Thank You.

Name: ____________________________________________ Official Stamp:

Title: _____________________________________________

Telephone: _____________________Fax:________________

Email:____________________________________________