APPENDIX 1

For Office Use :

Ijazah Sarjana Muda

Level
/ Bachelor
Reference APEL

APPLICATION FORM
ACCREDITATION OF PRIOR EXPERIENTIAL LEARNING (APEL)

FULL NAME (AS IN IC) NOR MUHAMAD HAPIZ BIN ABDUL MUTALIB
CORRESPONDENCE ADDRESS 73A, JALAN REJANG 10
TAMAN SETAPAK JAYA
53300 SETAPAK
WP KUALA LUMPUR

IC NUMBER 880802065163

DATE OF BIRTH 02 Aug 1988

GENDER MALE

CONTACT NUMBERS HOME: OFFICE: 0326036677 MOBILE: 0193655256

FAX: E-MAIL: apeh21@gmail.com

LEVEL AND FIELD OF STUDY Ijazah Sarjana Muda /

APPLIED Bachelor

APEL ASSESSMENT CENTER UNIVERSITI TEKNOLOGI MARA (UiTM)

HIGHEST LEVEL OF SPM / SPM

ACADEMIC QUALIFICATION (ENCLOSE A CERTIFIED COPY OF THE QUALIFICATION)

DECLARATION:
✔ I, NOR MUHAMAD HAPIZ BIN ABDUL MUTALIB (MyKad No: 880802065163) declare that all the information and
documents provided to support this application are authentic, true and accurate.
✔ I understand that my registration for the online application stated above may be considered invalid and MQA
reserves the right to reject my application if false or incorrect information submitted or I have not fulfilled the
APEL entry requirements.
✔ I agreed with this application which is subject to the following conditions:

1. Non-refundable application charge of RM250.00 for Bachelor Degree Level (APEL T-6) is payable to the
UNIVERSITI TEKNOLOGI MARA (UiTM) .
2. The applicant gives permission to Malaysian Qualifications Agency (MQA) to make references to and
use the information or data in this application as may be deemed necessary.
3. The applicant gives permission to Malaysian Qualifications Agency (MQA) to disclose my information to
the relevant third parties where required.
4. Documents that are not in English or Bahasa Malaysia must be accompanied by translations performed
by certified translator full.
5. Eligible applicant will sit for Aptitude Test and submit Portfolio.

✔ The MQA reserves the right to terminate the APEL Assessment process, for the candidate who failed to provide
any feedback or submission of the portfolio based on the stipulated time given.

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