Examination Unit, Registry

Application for Special Examination

This form should be completed if you were unable to attend a scheduled examination due to illness or other
special cause and MUST be lodged at your School’s office within three working days of the scheduled
examination paper.

A separate form should be completed for each subject for which a special examination is being requested.
The certification of a doctor in support of this application in case of illness MUST be completed (see overleaf).

The protection of personal data is an important concern to Sunway University and any personal data collected on
this form will be treated in accordance with the Personal Data Protection Notice of the institution.

Please write in BLOCK LETTERS

Name PANG JING YEE Student ID No. 20038790

School Exam Cycle
SUNWAY UNIVERSITY (Month & Year) JULY 2022
Programme BIB Intake AUG 2020
Examination for which application is made

Subject Subject Code Date of Examination

PRODUCT INNOVATION AND COMMERCIALISATION MKT 3204 19 JULY 2022

I require this special exam because:
My air flight had clashed with the exam so i could not attend the exam. thank you.
…………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………

Signature of Candidate: Date: 16/7/2022

Approval by Dean/Head of Department or Centre

□ Approved. Candidate will resit the examination with no penalty on the number of attempts.
□ Not approved. Candidate has to resit/repeat the examination as a second attempt.
Signature: Date:
Name:
Designation:

Form Effective: 2-Jan-2018

CERTIFICATION OF DOCTOR
IN SUPPORT OF THIS SPECIAL EXAMINATION APPLICATION

Medical Certificate by itself will not be accepted, please supply the information as set out below.

(To be filled in by student)

Name Intake

Student ID No. Study Year

CERTIFICATION BY DOCTOR

1. The above named student

………………….. …………………. .…………………..
consulted me on these dates:

2. This student has been Able to Sit the Exam:

disadvantaged at his/her □ Very severely □ Moderately □ Yes
examination □ Severely □ Slightly □ No

Date(s) disadvantaged: ……………………. to ………………………

3. This student has been Able to Study:
disadvantaged at times other than
or in addition to his/her
□ Very severely □ Moderately □ Yes
examination □ Severely □ Slightly □ No

Date(s) disadvantaged: ……………………. to ………………………

4. Please supply any relevant additional information relating to the ability of the student to prepare for and
sit the examination.

……………………………………………………………………………………………………………………………..

……………………………………………………………………………………………………………………………..

……………………………………………………………………………………………………………………………..

……………………………………………………………………………………………………………………………..

……………………………………………………………………………………………………………………………..

DECLARATION & DETAILS OF DOCTOR

I certify that I have seen the above student and the information I have supplied is true and correct.

Signature: …………………………………… Date: ………………… Doctor's Stamp

Name (BLOCK LETTERS please): …………………………………………..

Address: …………………………………………………………………………

…………………………………………………………………………

Privacy Notice:
Sunway University is committed to protecting and maintaining the privacy, accuracy and security of your personal and health
information and complies with the University’s privacy policies, commitments, guidelines and procedures which conform to and
support all privacy obligations that bind the University.