1.

AcSS
2. Student
UNIVERSITI KUALA LUMPUR
MALAYSIA ITALY DESIGN INSTITUTE
APPEAL TO SIT FOR FINAL EXAMINATION FORM
Student’s Name :
Student ID : NRIC/Passport No:
Programme : HP Number:
Current Semester :

Student’s Signature: _________________________ Date: _____________

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

Approved by:

Date:
Attach us the document to support my appeal.
*circle the related reason For Lecturer’s Approval

Code Lecturer’s sign % Att

BAR
for approval (after
approval)
REASON FOR BAR

Attendance

Course
Lecturer’s %
Code Course Name
Name Attended

For Finance Approval

Description Amount Approval &

Due Official
Stamp
Finance
Registration Yes
fee

No
Tuition fee
Sign:

Hostel Name:
For Examination Unit Use Only
Date:
Date received:
By:

*Note to students: kindly submit this form to your respective lecturers for approval. Supporting document such as Medical Certificate/
Letter from parent/ guardian must be submitted for medical/personal reason.