Madrasah Al-Hikmah

Surau Al-Hikmah, Jalan SS 18/4, 47500 Subang Jaya, Selangor Darul Ehsan
No PENDAFTARAN JAIS SPS/PRP/08/7(SEM)-303 Tel: 019-317 0255
019- 281 6307

APPLICATION FORM FOR 2011 INTAKE

PERSONAL DETAILS

Name : ____________________________________________________

Date of birth : ____________________________________________________

Father’s name : ____________________________________________________

Mother’s name : ____________________________________________________

Home address : ____________________________________________________

____________________________________________________

____________________________________________________

Telephone no : ____________________________________________________

Contact person & no: ____________________________________________________

EDUCATIONAL RECORD

School attended (or furthest secular education) ________________________________

Level achieved _______________________________________ in the year _________

Madrasah attended (or furthest Islamic education) ______________________________

Level achieved _______________________________________ in the year _________

HEALTH
Does the applicant suffer from any illness that would affect his studies or his stay at the
institute? If yes, specify.

________________________________________________________________________

________________________________________________________________________
FEES

Registration Fee
Registration fee is RM400. The payment is made on the acceptance of student to study in
the madrasah. The place of study shall not be reserved for student who has yet to pay this
fee.

Annual Fee
The annual fee is RM4800. Payment can be staggered into monthly payments. Payments
shall be acknowledged in periodical statements. The final settlement shall be not later than
October 2011.

Fees Card
All students shall be issued a FEES Card. In each occasion, please make sure that the
recipient of the fees is a member of the staff and signs the card to acknowledge the
respective payment.

All payments should be made to:

Name: MAH SJ Resources

Bank: Bank Muamalat SS15/5A Subang Jaya
NO: 1206-0002579-71-4

I the undersigned, in my capacity as PARENT/GUARDIAN/SPONSOR of ______________

________________________________________________, hereby undertake to pay the

fees as indicated above.

Name _______________________________________________

Signature _________________________________________

TAWKEEL
This section is to be signed by the applicant himself if he is mukallaf, and by his parent or
guardian if he is not. Cross out the no applicable words in capitals:

The APPLICANT / THE APPLICANT’S PARENT / THE APPLICANT’S GUARDIAN hereby

appoints the principal of the Madrasah as his unfettered wakeel (agent) to receive and
disburse of any funds, including zakah where there is eligibility, on behalf of the applicant.

Name _______________________________________________

Signature _________________________________________
ACCEPTANCE
1. Submission of this form shall be considered as a formal application to study in the
institution.
2. The decision of acceptance shall be made after a muzakarah session between the
parents/guardians and mudir. The prospective student may be present.
3. The madrasah shall inform the applicant the status of the application as soon as
possible, insyaAllah.
4. Application shall not be processed if the document ‘DECLARATION OF PARENTS’
has not been signed. Kindly read carefully and sign only if you have agreed on all
the terms mentioned.

Sponsor
Sponsor is responsible for the fees and all other expenses of the students

Name: _______________________________________________

Relationship: ________________________________________________

Address: ________________________________________________

________________________________________________

Telephone: ________________________________________________

Email: ________________________________________________

Guardian
Guardian is a muhrim responsible for the student for the period of time
outside madrasah

Name: _______________________________________________

Relationship: ________________________________________________

Address: ________________________________________________

________________________________________________

Telephone: ________________________________________________

Email: ________________________________________________

Visa
The madrasah is not responsible for the application of the student’s visa,
but shall generate the letter of offer (if accepted) required by the religious
office (JAIS) and immigration office. The guardian is kindly requested to
make all the necessary arrangement.
 DECLARATION OF PARENTS/GUARDIAN

I hereby agree that:

1. The parents shall not intervene in the operation of the madrasah. Any feedback
must be addressed to the mudir in writing.

2. The madrasah will do its utmost to take care of the student’s safety, but is NOT
responsible for any mental or physical harm that may befall the student for all
time during the stay in the madrasah or away from the madrasah.

3. Punctuality is of high importance. Disciplinary action shall be taken on students

returning late to the madrasah.

4. Any item(s) found in possession of the student, which have been ruled
impermissible by the madrasah, will be confiscated. It is entirely up to the
madrasah to do what is deemed necessary with the confiscated item(s). The
parents have no more rights over the item(s).

5. The madrasah will inform the student and may update the parents of the items
which have been declared impermissible by the madrasah.

6. The madrasah has the right to expel the student who is found to be unfit,
academically or behaviourally, to continue his/her study in the madrasah.

We put our trust in Allah swt.

Name of Student: ……………………………………….

Signature of parent/guardian……………………………….

Name of parent/guardian: …………………………………………………….

Date: ……………………..