Residence Application Form Page 2
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4PARENT(S) OR GUARDIAN(S) PARTICULARS
Name of Parent/Guardian
:
Relationship
:
Occupation
:
Company
:
Contact Address
:
House phone
:
Fax
:
Mobile phone
:
E-mail
:
* All correspondence will be directed to the contact person as specified above
EMERGENCY CONTACT
Name of Contact Person
:
Relationship
:
House phone
:
Fax
:
Mobile phone
:
E-mail
:
MEDICAL HISTORY
Allergies
:
Blood Type
:
If you are physically disabled, please state the nature of the disability. If not, please write “Nil”.
Any medical condition which may be of concern:
CHECK-LIST
I hereby enclose the following with this application (please tick () where necessary) :
Two passport-size photographs
Certified true copy of I.C. (both sides) for Malaysian Students / Passport Identification Page for International Students
Mode of payment for Residence Application Fee (MYR500)
*Cash
Bank Draft
Telegraphic Transfer
Cheque
* Please do not enclose / mail cash together with this application
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Parent category: Business