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BORANG PERMOHONAN
SURAT PENGESAHAN PENGIKTIRAFAN KELAYAKAN
(LUAR NEGARA)

MAKLUMAT PEMOHON

1. Nama Pemohon (Huruf Besar seperti IC): __________________________________________

2. Alamat Pemohon:
____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

3. No. Kad Pengenalan: __________________________________________________________

4. No. Telefon: _________________________ 5. E-mel: _____________________________

1. MAKLUMAT KELAYAKAN PENGAJIAN

a) Peringkat Kelayakan / Program*:

Ijazah Pertama Diploma Sijil Lain-lain _________________

b) Nama Kelayakan / Program yang dipohon pengesahan:

____________________________________________________________________________

c) Nama Universiti / Institusi dan Negara yang menganugerahkan Kelayakan:

____________________________________________________________________________

d) Tempoh Pengajian untuk Mendapatkan Kelayakan:

____________________________________________________________________________

e) Mod Program: Sepenuh masa / Separuh masa / Pengajian Jarak Jauh / Distance Learning
(potong mana yang tidak berkenaan)

f) Tarikh bergraduat: _________________________________________________________

2) Tujuan Surat Pengesahan Diperlukan:

____________________________________________________________________________
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Saya mengakui segala keterangan yang diberi adalah benar. Bersama ini disertakan salinan dokumen
yang diperlukan yang telah disahkan oleh Pegawai Kerajaan dari Kumpulan Pengurusan & Profesional
atau notari awam.

Sila tandakan (/)

Salinan Kad Pengenalan
Salinan Sijil dan Transkrip Kelayakan (dalam bahasa
asal)
Salinan Sijil dan Transkrip Kelayakan (yang telah
diterjemah ke dalam Bahasa Inggeris)
Salinan Surat Tawaran (sekiranya ada)
Salinan Surat Penajaan (sekiranya ada)
Bank Draft RM100 atas nama : AGENSI KELAYAKAN
MALAYSIA

Tanda tangan : ____________________________________________________________

Nama Pemohon : ____________________________________________________________

Tarikh : ____________________________________________________________

*Sila tandakan ( / ) mengikut petak yang berkenaan

Nota:

* MQA berhak untuk mendapatkan maklumat / dokumen sokongan daripada pemohon sekiranya
perlu.

* Pemohon hendaklah mengemukakan dokumen versi terjemahan dalam Bahasa Inggeris sekiranya
dokumen tersebut menggunakan bahasa asing selain Bahasa Inggeris.

* Borang yang telah lengkap diisi hendaklah dimajukan kepada:

Bahagian Koordinasi dan Rujukan Jaminan Kualiti

Agensi Kelayakan Malaysia
Mercu MQA, No. 3539
Jalan Teknokrat 7, Cyber 5
63000 Cyberjaya.
Selangor Darul Ehsan.
Phone: 03-8688 1900 Fax: 03-8688 3600
E-mail: esisraf@mqa.gov.my

UNTUK KEGUNAAN MQA

_________________________________________________________________________________

Status Permohonan:

Lengkap Tidak Lengkap

Status Pengiktirafan:

Diiktiraf Belum Diiktiraf / Tidak Diiktiraf

Disemak oleh: Disahkan oleh:

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APPLICATION FORM
RECOGNITION OF QUALIFICATION LETTER
(FOREIGN QUALIFICATIONS)

APPLICATION DETAILS

5. Name of Applicant (Capitalization such as IC): ______________________________________________

6. Mailing Address: _____________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

7. IC Number: __________________________________________________________________________

8. Phone No.: ______________________________ 5. E-mail: _________________________________

2. INFORMATION OF THE QUALIFICATION

a) Level of Qualification*:

Bachelor Degree Diploma Certificate Other: ___________________

b) Title of Qualification:

____________________________________________________________________________________

c) Name of Awarding Institution and Country of Awarding Institution:

____________________________________________________________________________________

d) Duration of Study:

____________________________________________________________________________________

e) Mode of Study*: Full Time / Part Time / Distance Learning

f) Year of Graduation: ______________________________________________________________

3. Purpose of Applying for Recognition Letter:

____________________________________________________________________________________
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I hereby declare that all the information and documents provided to support this application are true,
correct and accurate. Enclosed herewith the documents certified by Malaysian Government Officials
(Grade A) or notary public:

Please tick (/)

A copy of Identity Card/Passport
A copy of original certificate and / or transcript (in native
language)
A copy of certificate and / or transcript (in English)
A copy of offer letter (if applicable)
A copy of sponsorship letter (if applicable)
Bank Draft RM100 paid to : AGENSI KELAYAKAN MALAYSIA

Signature : ___________________________________________________________________

Name of Applicant : ___________________________________________________________________

Date : ___________________________________________________________________

* Please tick (/) or cross out as appropriate

Notes:
* If necessary, MQA has the right to request for additional information/ documents to support the
assessment.

* Each applicant must provide an English translation if the original document is written in native
languages.

* Please submit your complete form and document to :

Coordination and Quality Assurance Reference Department

Malaysian Qualifications Agency
Mercu MQA, No. 3539
Jalan Teknokrat 7, Cyber 5
63000 Cyberjaya
SELANGOR DARUL EHSAN.
Phone: 03-8688 1900 Fax: 03-8688 3600
E-mail: esisraf@mqa.gov.my

FOR INTERNAL USE ONLY

__________________________________________________________________________________________

Application Status:

Complete Incomplete

Recognition Status:

Recognise Not Recognise

Checked by: Verified by: