TUNKU ABDUL RAHMAN UNIVERSITY OF MANAGEMENT AND TECHNOLOGY

Department of Examinations and Credit Accumulation

APPLICATION FORM FOR EXTENUATING MITIGATING CIRCUMSTANCES (EXAMINATIONS)

STUDENTS DETAILS
Student Name Registration No.
IC. NO Year and Semester
Programme of Study Session
Address:
Tel. No. (H) (H/P)

*Absent from Examination / Late for Examination

(*Please underline whichever is applicable)
Course Code Description Date of Exam Venue Session
(am/pm/vm)

Reason(s) being absent from examination / late for examination (please give a brief description of the extenuating
circumstances)
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The form should be returned to the Department /Division of Examinations and Credit Accumulation within 48 hours
of the affected extenuating circumstances. Students of the Branches are to submit the form and relevant
documents to the respective Branch.

Please tick (√) No document to support my application.

Relevant Document(s) to support my application. (Please indicate)

_________________________________________________________________________

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Signature: ____________________ ___ Date: ________________________________

For Department / Division of Examinations and Credit Accumulation Use:

Received by: ___________________________ Date: ________________________________