GAMBAR

BERUKURAN
PASPORT/PASSPORT-
SIZED PHOTOGRAPH



Perhatian :
Sila rujuk kepada Garis Panduan Permohonan
Attention :
Please refer to the Application Guideline

SILA GUNAKAN HURUF BESAR
PLEASE USE CAPITAL LETTERS
A. PROGRAM PILIHAN/CHOICE OF PROGRAMMES PREFERRED
PROGRAM PERINGKAT DIPLOMA/
DIPLOMA LEVEL PROGRAMME
URUTAN PROGRAM PILIHAN/
SEQUENCE OF PROGRAMME CHOSEN (1-3)
(DIISI OLEH PEMOHON/FILLED BY APPLICANT)
UNTUK
KEGUNAAN
PEJABAT/
FOR OFFICE USE
1. Diploma Pengurusan/
Diploma In Management
PILIHAN/CHOICE :
2. Diploma Pengurusan Sumber Manusia/
Diploma In Human Resource Management
PILIHAN/CHOICE :
3. Diploma Pengurusan Perniagaan/
Diploma In Business Management
PILIHAN/CHOICE :

B. MAKLUMAT PERIBADI/PERSONAL PARTICULARS

NAMA PENUH/FULL NAME:

NO. KAD PENGENALAN/ NO. PASPORT :
NRIC NO / PASSPORT NO

JANTINA/SEX:

KELAINAN UPAYA/DISABILITY: TIADA/NO
ADA/YES
TANDAKAN MANA YANG BERKENAAN/TICK WHERE APPLICABLE

TARIKH LAHIR/DATE OF BIRTH: NEGERI LAHIR/STATE OF BIRTH:
NO. TELEFON (RUMAH) :
TELEPHONE NO. (HOUSE)
NO. TELEFON BIMBIT/
MOBILE PHONE NO:
BORANG PERMOHONAN KEMASUKAN
APPLICATION FOR ADMISSION
TARAF PERKAHWINAN/
MARITAL STATUS:
AGAMA/RELIGION:
KETURUNAN/RACE:
KEWARGANEGARAAN/
NATIONALITY:
ALAMAT E-MEL/EMAIL ADDRESS:
ALAMAT SURAT-MENYURAT/CORRESPONDENCE ADDRESS:










NEGERI/STATE: POSKOD/POSTCODE:

C. MAKLUMAT IBU BAPA/PENJAGA/PARENTS/GUARDIANS INFORMATION

*POTONG YANG TIDAK BERKENAAN/DELETE WHICHEVER IS NOT APPLICABLE
NAMA IBU BAPA/PENJAGA/PARENTS/GUARDIANS NAME:

PEKERJAAN IBU BAPA/PENJAGA/PARENTS/GUARDIANS OCCUPATION:


NO. TELEFON (RUMAH)/
TELEPHONE NO. (HOUSE):
NO. TELEFON BIMBIT/
MOBILE PHONE NO:
ALAMAT E-MEL/EMAIL ADDRESS:
ALAMAT SURAT-MENYURAT/CORRESPONDENCE ADDRESS:









NEGERI/STATE: POSKOD/POSTCODE :


D. KELAYAKAN AKADEMIK/ACADEMIC QUALIFICATION

SPM/SPMV/O-LEVEL Tahun/Year

Aliran/Stream: Sastera/Arts Sains/Science

Keputusan/Result SPM/SPMV/O-LEVEL
(Isikan grade /Fill in the grade : A+, A/1A, A-/2A, B+/3B, B/4B, C+/5C, C/6C, D/7D, E/8E, G/9G)
MATA PELAJARAN/SUBJECT
GRED/
GRADE
MATA PELAJARAN/SUBJECT
GRED/
GRADE
BAHASA MALAYSIA/MALAY LANGUAGE
BAHASA INGGERIS/ENGLISH LANGUAGE
MATEMATIK/MATHEMATICS
SAINS/SCIENCE
BIOLOGI/BIOLOGY
FIZIK/PHYSICS
KIMIA/CHEMISTRY
MATEMATIK TAMBAHAN/
ADDITIONAL MATHEMATICS

GEOGRAFI/GEOGRAPHY
SEJARAH/HISTORY
PENDIDIKAN ISLAM/ISLAMIC EDUCATION
PENDIDIKAN MORAL/MORAL EDUCATION
PRINSIP PERAKAUNAN/PRINCIPLES OF ACCOUNTING
PERDAGANGAN/COMMERCE
EKONOMI ASAS/BASIC ECONOMICS

E. MAKLUMAT AKTIVITI KOKURIKULUM/EXTRACURRICULAR ACTIVITIES
Butir-butir aktiviti sukan/persatuan/Details of sport/society activities
TAHUN/
YEAR
SUKAN/PERSATUAN/SPORT/SOCIETY
PERINGKAT PERWAKILAN/REPRESENTATIVE LEVEL
SEKOLAH/
SCHOOL
NEGERI/
STATE
NEGARA/
NATIONAL





F. PEMBIAYAAN PENGAJIAN / FINANCING OF STUDIES

TANDAKAN MANA YANG BERKENAAN/TICK WHERE APPLICABLE

PTPTN

KWSP IBU BAPA/PARENTS EPF

LAIN-LAIN/OTHERS

SILA NYATAKAN/PLEASE STATE : ________________________________________________
G. SENARAI SEMAK PERMOHONAN/APPLICATION CHECKLIST
Sila Tanda / Please Tick
Borang Permohonan yang telah lengkap / A duly completed Application Form
Salinan sijil-sijil berkaitan yang telah disahkan (SPM / SPMV / O-Level) / Certified Copies of relevant certificates (SPM /
SPMV / O-Level)
Salinan Dokumen-dokumen Sokongan yang telah disahkan/Certified Copies of Supporting Documents
Bayaran Pemprosesan sebanyak RM25.00 (tidak dikembalikan) / Processing fees of RM25.00 (non-refundable)
H. PERAKUAN PEMOHON/APPLICANT'S DECLARATION
Saya mengaku bahawa semua keterangan dan bukti yang saya berikan di dalam permohonan ini adalah benar. Saya sedia
maklum bahawa pihak Pusat Pendidikan Berterusan Universiti Malaya (UMCCed) berhak menolak permohonan ini atau menarik
balik tawaran program pada bila-bila masa sekiranya mana-mana keterangan atau salinan sijil-sijil yang dikemukakan adalah
tidak benar.

I declare all the information and proof given in this application is true. I understand that University of Malaya Centre for
Continuing Education (UMCCed) has the right to withdraw or terminate this offer at anytime if the information or copy of
certificate (s) given by me in this application are false.



______________________________________ ____________
Tandatangan Pemohon /Applicant's Signature Tarikh/Date
UNTUK KEGUNAAN PEJABAT/FOR OFFICE USE

Tarikh Terima/Date Received:__________________________________________________

Tarikh Semak/Date Checked: __________________________________________________

Disemak Oleh/Checked By: __________________________________________________

Senarai Semak/Checklist Catatan/Remarks
Borang Permohonan/
Application Form

Salinan Sijil/
Copy of Certificate

Dokumen Sokongan/
Supporting Document

Bayaran Proses/
Processing Fee


KOD RUJUKAN/REFERENCE CODE


GARIS PANDUAN PERMOHONAN/APPLICATION GUIDELINE

A. Borang Permohonan/Application Form
Borang Permohonan hendaklah diisi dengan lengkap.
The Application Form must be duly completed.

B. Dokumen Sokongan/Supporting Documents
Sila lampirkan salinan dokumen yang telah disahkan seperti tersenarai di bawah:
Please attach certified copies of documents as listed below:

i. 1 salinan MyKad/Kad Pengenalan
1 copy of MyKad/Identification Card

ii. 1 salinan sijil SPM / O-Level
1 copy of SPM/O-Level certification

iii. 2 keping gambar berukuran pasport
2 copies of passport-sized photograph


* Semua salinan sijil dan dokumen mestilah disahkan oleh Pegawai Kerajaan dalam Kumpulan
Pengurusan/Profesional.

* All copies of certificates and documents must be certified by a government officer from the
Management/Professional Group.


C. Yuran Pemprosesan/Processing Fee
RM25 (Wang pos/Kiriman Wang) atas nama UMCCed (tidak dikembalikan).
RM25 (postal order/money order) made payable to UMCCed (non-refundable).


Borang Permohonan yang telah lengkap diisi (item A) perlu dihantar bersama dokumen sokongan
(item B) beserta Yuran Pemprosesan (item C) sama ada melalui Pos atau serahan tangan ke alamat
berikut:

The completed Application Form (item A) must be submitted together with the supporting documents
(item B) and a processing fee (item C) and to be sent either by post or by hand to the following
address:

Pusat Pendidikan Berterusan Universiti Malaya (UMCCed)
Aras 7, Wisma R & D Universiti Malaya
Jalan Pantai Baharu
59990 Kuala Lumpur
(u/p: BPPPK)

Pemohon hendaklah menyertakan bersama sampul surat berukuran 38cm x 25cm (Saiz A4)
yang beralamat sendiri serta bersetem RM1.00. Sila tuliskan program yang dipohon di sebelah atas
kiri sampul surat.
Applicants are required to enclose a self-addressed envelope 38cm X 25 cm (A4 size) with stamp
(RM1.00). Please write the name of the programme applied on the top left side of the envelope.