NETHERLANDS MARITIME INSTITUTE OF TECHNOLOGY INDUSTRIAL TRAINING APPLICATION FEEDBACK FORM ‘Name. THEA GON thats emus roar Som BHO-Tel No. t Oe2 -482 484 Address tot 2, Bode F, mrLo,qann, fwmeFaxNe, — ? OF2 - 4a Hu) Lema 3, Domeale Lat laduretal Peote. ABOrD \ndlndy tenor ‘We agreeldisagree to accept the following ‘students to undergo industrial ‘training in.our.company: ‘No | ‘Name ‘Student ID Programme ' 1 [Rams TORT Ponies BARS Dae A HaeRE | OND TAIN [soroltl | TER OTR ON Meee 2 : | 1 DateofReport =: 3 yanuaen, BOUL | Lok 22, Bloke T, mrED Talen emt Leth 3, Demate test Company Address = iasyin\ Gare, AZOTS — Watclnny , Sarmionte Time ofReport =: 3-00 xm, We are also prepared to provide the following facilities for the students: Tick (%) where applicable: YES NO YES NO 4. Accommodation 3. Food and beverage 2, Transportation 4, Monthly allowance RM_250/~ Other Facilities (please state if. an; 23(AAIATR2501/018) ‘We also make it obligatory for students involved to fulfil the following aspects : Please return the complete form to : Industial ‘Training Coordinator, Netheriands Maritime Institute of Technology, Level 11-14, Kotaraya Office Tower, Galleria@ Kotaraya Jalan Abduliah Ibrahim 80000 Johor Bahru JOHOR DT Tel: +6072272020 Fax to: +6072271818 Web: www.nmit.edu.my Or email to liyana@nmit.edu.my 24