MUET APPLICATION FORM

YEAR : __________
(Please filled up the form and tick ( √) the check box as required)

MUET EXAM SESSION : 1 2 3

Candidate Name :
………………………………………………………………………………………………………

Faculty/School/Program :
………………………………………………………………………………………………………

Matrix Number :
………………………………………………………………………………………………………

IC. OR Passport Number : ………………………………………………………………………………………………………

Gender : Male Female

Nationality : Malaysian Others ; Please State : …………………………………….

Race :

Malay
Chinese
Indian
Others :
Kayan Bumiputera
Kelabit Melanau
Lun Bawang Kadayan
Kenyah Jawa
Punan Bugis
Orang Asli Iban
Bumiputera Sabah (Bajau) Bengali & Punjabi
Bumiputera Sabah (Melayu Brunei) Filipino
Bumiputera Sabah (Kadazan) Indonesia
Bumiputera Sabah (Murut) Bidayuh

English Results Grade during SPM/SPMV/GCE/MCE (for local std only) : ………………………………………

Phone Number : -

Please state & attach a copy

Special Needs Candidate : Yes
of OKU card
: ………………………………………

No

Fee payment : BSN MSU Account Department

Applicant signature : ……………………………………………………….

Date : ……………………………………………………….

Note:
**Please attached MEC PIN @ a copy of payment receipt & IC upon submission of this form.

For internal use only

MEC PIN / Receipt number : …………………………………………………. Stamp :

Received by : ………………………………………………….

Date : ………………………………………………….