STUDENT STATUS MODIFICATION FORM

COMPLETION : COMPLETION OF STUDY AND APPLICATION FOR REFUND OF DEPOSITS

WITHDRAWAL : CESSATION OF STUDY AND APPLICATION FOR REFUND OF DEPOSITS
DEFERMENT : APPLICATION FOR LEAVE OF ABSENCE
TRANSFER : APPLICATION FOR TRANSFER OF PROGRAMME/INTAKE/PREMISES
Important information: 1) Kindly complete this form with Adobe Acrobat 6.0 or higher; and
2) Please do not alter the contents and formatting of this form.

PERSONAL AND PROGRAMME PARTICULARS

Name POON XIAO ERN
(As in NRIC/Passport)
NRIC/Passport No. 000105101642 Student ID 18034868
Contacts Mobile No.: 0166166003 Personal Email: emika0015ern@gmail.com
Programme ACCA Intake JULY 2020

Malaysia Student Pass Expiry Date

Nationality
(For International Student only)

STUDY STATUS PARTICULARS (Please choose and state the details of your application)
□ Completion □ Transfer □ Programme (Please specify)
□ Withdrawal □ Intake (Please specify)
□
✔ Deferment From 09-2022 To 12-2022 □ Premises (Please choose) □ Bandar Sunway □ Sunway College at Velocity
(MM-YYYY) (MM-YYYY)
REASON(S) [Please choose the most applicable reason]
Academic Transfer Financial Personal Others
Progressing to Higher Level at Sunway Transfer to Other Institution (Articulation Arrangement) Financial Difficulties Health Issue ✔ Self-study Currently Working
Programme: Institution Name:
Received Scholarship Elsewhere Family Issue Friend Issue Seek Employment
Unable to Cope with Programme Programme Local Foreign
Difficulty with Level of English Taking a break Student Visa Issue
Transfer to Other Institution (Non-Articulation Arrangement)
Difficulty with Maths Components
Staff Issue
Change of Interest
Institution Name: Academic Staff Issue
Did not Meet Entry Requirements
Programme: Administrative Staff Issue Return to Home Town/Country Others
Do not Prefer Online Learning

REFUND PARTICULARS [For Completion/Withdrawal only. Please specify the payment option for refund (subject to bank charges)]
□ Donate □ ALL □ RM ____________ to Jeffrey Cheah Foundation. Tax Exemption Reference: LHDN.01/35/42/51/179-6.6370
□ By Cheque □ Crossed cheque □ Open cheque (only applicable to International students with no local bank account)
By IBG/ Account No. Bank
□
Telegraphic Transfer (Please state name, branch and country)

*only applicable for overseas bank account Currency* Swift Code* IBAN No./BSB Code/ IFSC Code* (if applicable)
Please specify the payee for refund
□ Self □ Father □ Mother □ Guardian (as specified in your application form)
Name NRIC/Passport No.
Please specify the collection method for refund by cheque or Official Receipt for donation to Jeffrey Cheah Foundation
□ Collect personally or by the payee (only applicable to International students) □ Post by mail [Please provide full address. (Note: overseas address using P.O. Box is not allowed)]

□ Collect on behalf of payee (Note: A letter of authorisation is required)

IMPORTANT NOTES AND MANDATORY DECLARATION

Completion/Withdrawal Processing Time
1. Application for refund must be made within 12 calendar months from your last day of study. Completion/Withdrawal
2. In the case of withdrawal, the return of your student ID card is mandatory if one has been - Approximately 20 working days upon confirmation of completion/withdrawal of
issued to you, failing which a penalty of RM47.00 will be imposed respectively. programme (excluding Saturday, Sunday and public holidays).
3. All Sunway College equipment/property in your possession (e.g. books borrowed from the Deferment/Transfer
Sunway Campus Library) must be returned to the relevant departments. - Approximately 7 working days from the submission date of this form (excluding
Saturday, Sunday and public holidays).
Deferment
1. Application has to be made BEFORE the commencement of the study period you wish to Supporting Documentation
defer.
2. A deferment is normally granted for a period of ONE semester. The total period of □ I enclose a letter/copy of air-ticket/other supporting document(s) for this application.
deferment allowed for a programme is ONE calendar year, after which you will be required Please read the following carefully and sign and date here before submitting this form
to withdraw from the programme. to:
For International Student • For students attending the Bandar Sunway premises:
- You must submit a copy of your confirmed air-ticket to your home country. - Registry (Malaysian Student) or International Office (International Student)
- Upon arrival at your home country, you are required to scan the exit stamp in your • For students attending the Sunway College at Velocity premises:
passport (latest exit date from Malaysia) and send via email to the International Office at - Information Centre
int_admin@sunway.edu.my.
- International Student (student pass holder) must submit original passport for the student I hereby undertake that I am fully aware of and will be bound by the Sunway College
pass cancellation/shortening before you can submit this form. rules and regulations for this application.
I declare that all the particulars relate to me and are correct.
Transfer
1. You must meet the requirements of the new programme.
2. The return of your student ID card is mandatory if one has been issued to you, failing Signature
which a penalty of RM47.00 will be imposed respectively.
3. You must continue attending classes/lessons in the current programme until you have
received a letter confirming your transfer. Important: Before signing, please key in your Name and Date below. Once signed, form may no longer be editable
(depending on the Acrobat version used during completion of this form).
Eligibility Criteria
You are eligible to apply for completion/withdrawal/deferment/transfer if: Name POON XIAO ERN
- You do not have any outstanding payment with Sunway College; and
- You are fully aware and accept that you will comply with the rules and regulations of Date 1/10/2022
Sunway College.
(Version: 14122021)
1
 FOR OFFICE USE ONLY
(This section must be endorsed by a senior staff member from the relevant School or Academic Department)
Approval from School / Academic Department (NEW programme) Approval from School / Academic Department (CURRENT programme)
[Only applicable for students who are transferring programme/premises]
□ Approved □ Approved
□ Full Offer Remarks
□ Conditional Offer (with the following conditions)
□ Actual results to meet programme entry requirements
□ Produce original academic documents for verification
□ Other conditions (please specify) Note: Remarks in this section will be considered as official and entered into EMX

□ Not Approved [please specify reason(s) for rejection]

□ Not Approved [please specify reason(s) for rejection]

Signature Signature
Important: Before signing, please key in your Name and Date below. Once signed, form may no longer be editable Important: Before signing, please key in your Name and Date below. Once signed, form may no longer be editable
(depending on the Acrobat version used during completion of this form). (depending on the Acrobat version used during completion of this form).
Name Name
Date Date
Approval from Centre for English Language Studies (For students who are enrolled in the Intensive English Programme and one other programme)
Remarks
Signature
Important: Before signing, please key in your Name and Date below. Once signed, form may no longer be editable
(depending on the Acrobat version used during completion of this form).
Name
Date

INTERNATIONAL OFFICE [Please indicate with a tick (√)] THE REGISTRY [Please indicate with a tick (√)]
□ Return of Student ID card (for withdrawal/transfer programme/intake/premises only) □ Return of student ID card (for withdrawal/transfer programme/intake/premises only)
□ Returned □ Not Returned □ Returned □ Not Returned
□ Updated status in the EMX □ Updated status in the EMX
□ Updated student pass □ Printed and issued letter of notification (not applicable for completion)
□ Verified air-ticket □ Printed and issued new student ID card (for transfer programme/intake only)
□ Verified passport (included all stamped pages; for cancellation of student pass) □ Printed and issued letter of offer (M’sian student for transfer of programme/intake only)
□ Received a copy of the passport information page
□ Received a copy of the passport entry stamp/offer letter
□ Printed and issued letter of offer (Int’l student for transfer of programme/intake only)
Remarks Remarks

Signature Signature
Important: Before signing, please key in your Name and Date below. Once signed, form may no longer be editable Important: Before signing, please key in your Name and Date below. Once signed, form may no longer be editable
(depending on the Acrobat version used during completion of this form). (depending on the Acrobat version used during completion of this form).

Name Name
Date Date

For enquiries please contact the following department, whichever relevant:

For students attending the Bandar Sunway premises:
• Malaysian student: +603 7491 8622 (Extension 8772/8137)
• International student: +603 7491 8622 (Extension 3824)
Or send an email to srga-op@sunway.edu.my (please provide your name as in NRIC/Passport, student ID number, programme and intake).

For students attending the Sunway College at Velocity premises:

• +603 9770 1155 (Extension 1118)
Or send an email to administration-sv@sunway.edu.my (please provide your name as in NRIC/Passport, student ID number, programme and intake).

Data protection
The protection of personal data is an important concern to Sunway College and any personal data collected on this form will be treated in accordance with the Personal Data Protection
Notice of the institution [http://sunway.edu.my/pdpa/notice_english (English version) or http://sunway/edu.my/pdpa/notice_BM (Malay version)].