OK. MALAYSIAN INSTITUTE OF eMC AVIATION TECHNOLOGY DCAM Part 66 Module Examination Application Form APPLICANT DETAILS Name: NRIC/Passport No: Contact No: COUnIKL-MIAT Student (in-study) luniKL-MIAT Alumni Candidate | UniKL-MIAT EASA Category CIUniKL-EASA ONLY Clexternal Candidate EMal Program Category Applied Tick box f first time sitting for the applied module examination. Date of previous module exam sitting if this is not the first sitting EXAMINATION MODULES Note: Students are only allowed to apply for one (1) module at any one (1) time. Mark V where Modul roautes applicable Consolidation class date confirm (if first exam sitting) (For UnIKL MIAT uso only) Examination date confirm (For UniKL MIAT use only) Module 1 Module 2 Module 3 Module 4 Module 5 Module 6 Module 7 Module & Module 9 Module 10 Module 118 (Module 118 Module 12 Module 13 Module 14 Module 15 Module 16 G)ojo}o}ofojojojayo}a}a}ajojoj}ojojo Module 17 | wish to apply for the examination module as indicated and confirm that the information contained in this form is correct atthe time of application, Copies of SPM and related examination result slip are attached. | also confirm that fon the date ofthis application, 'm not being barred from taking module examination, Signature: Date: For Unik MIAT use only Exam Fee Received RM Receipt Number Consolidation Class Fee Received (fapplicable) | Receipt Number Signature Date