BAHAGIAN HAL EHWAL PELAJAR | ​STUDENT AFFAIRS DIVISION

BORANG AKUAN PERMOHONAN PERGERAKAN PELAJAR

STUDENT MOVEMENT APPLICATION FORM
(PERINTAH KAWALAN PERGERAKAN BERSYARAT)
(CONDITIONAL MOVEMENT CONTROL ORDER)

BAHAGIAN A : MAKLUMAT PELAJAR | ​PART A : STUDENT INFORMATIO​N

NAMA PELAJAR
STUDENT NAME

NO. K/P NO. TELEFON

I/C NO. PHONE NO.

JANTINA PERINGKAT PENGAJIAN

GENDER LEVEL OF STUDY

NO. MATRIK LAMA NO. MATRIK BAHARU

OLD MATRIC NO. NEW MATRIC NO.

PROGRAM PENGAJIAN
PROGRAMME NAME

FAKULTI
FACULTY

EMEL
EMAIL

TANDATANGAN TARIKH
SIGNATUR​E DATE

BAHAGIAN B : MAKLUMAT TAMBAHAN | PART B : ADDITIONAL INFORMATION

ALAMAT SEMASA
CURRENT ADDRESS

ALAMAT TETAP
PERMANENT ADDRESS

NAMA PENJAGA
NAME OF GUARDIAN

NO. TELEFON
PHONE NO.

BAHAGIAN C : PENGESAHAN BHEP | PART C : MASTER/BHEP VALIDATION

CATATAN/NOTES: TANDATANGAN PENGETUA/BHEP:

MASTER/BHEP SIGNATURE: