UNIVERSITI KUALA LUMPUR

MALAYSIAN INSTITUTE OF CHEMICAL AND BIO ENGINEERING TECHNOLOGY

(MICET)
RETURN TO HOMETOWN APPLICATION FORM
NAME : Nik Mohamad Faiz Bin Dakhlan ID NO: 55101120058

PROGRAMME: DCB SEMESTER: sem 1 julai 2020

ADDRESS THAT YOU ARE GOING TO STAY DURING THIS SEMESTER (July 2020) :

Lot 1505, Kampung Kedai Baru Banggu, 16150 Kota Bharu, Kelantan

HANDPHONE NUMBER : 01129577921 GUARDIAN NAME AND TEL. NO :

Ariffin bin Yusuf
0179744645

DATE APPLIED : 5 December 2020 SIGNATURE : nik Faiz

RECEIVED BY : APPROVED BY :
(AcSS) (DDAT)

I hereby ensure that I possess a good and stable Internet connection and adequate devices
to continue my study online. In addition, I promise to bring my books, laptop and other
essential items needed to complete my study at home as has been stipulated in Beyond C No. 8
announcement.
Students are reminded to log in and  complete the UniKL MAC location and health declaration form on a
daily basis (including weekends).

Office use :

- PAU to attach July 2020 course registration slip and timetable with this form.