1.

AcSS
2. Student
UNIVERSITI KUALA LUMPUR
MALAYSIA ITALY DESIGN
INSTITUTE
APPEAL TO SIT FOR FINAL EXAMINATION FORM
Student’s Name:
ARIFF AIMAN
BIN MUKDATH
Student ID : 58220121091 NRIC/Passport No: 980115565375
Programme : BACHELOR OF TECHNOLOGY MANAGEMENT HP Number: 0135153234
Current Semester: 2

Student’s Signature: Date: 8 JUNE 2022

Medical Leave FOR OFFICE USE ONLY

For Examination Unit Approval

Due to medical / personal* reason, I would like to sit for the
following examination:
Subject Examination Unit Approval
code No Yes Exam date
Subject Code Subject Name

PXB10203 SAFETY HEALTH ENVIROMENT

Approved by:

Attach us the document to support my appeal. Date:

*Circle the related reason
For Lecturer’s Approval

BAR Code Lecturer’s sign % Att

for approval (after
REASON FOR BAR approval)

Attendance

Course
Lecturer’s %
Code Course Name
Name Attended
PXB10203 SAFETY HEALTH SHUKRI BIN 58.33
ENVIROMENT
MOHAMMED
SALLEH

For Finance Approval

Description Amount Approval &
Due Official
Stamp
Finance
Registration Yes
fee

No
Tuition fee
Sign:

Hostel Name:
*Note to students:
Forkindly submit this Unit
Examination form to
Useyour respective lecturers for approval. Supporting document such as Medical Certificate/
Only
Letter from parent/ guardian must be submitted for medical/personal reason.
Date:
Date
received: By: