REGISTRATION

DOCUMENT

REGISTRAR OFFICE (Admission Unit)

Appendix A(3) Students Biodata Form

Appendix B(1) Medical Certification Form

Appendix B(2) Financial Guarantee Form

Appendix B(3) Students Declaration Form

Appendix B(4) Finances Declaration Form

Appendix C Students Pledge

Kindly complete this document before registration and submit on the

scheduled orientation day.

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APPENDIX A (3)

STUDENTS BIODATA FORM

PERSONAL PARTICULARS (CAPITAL LETTERS) STUDENT ID NO. : ________________________________

Full Name

Date of Birth

IC No.

Marital Status

Gender

Race

Religion

Contact Number

Permanent Address

Correspondence Address

Parents / next of kin who can be contacted in case of emergency Name

Address

Contact No.

IC No.

Please affix

a copy of your

passport sized photo

here.

2

FAMILY BACKGROUND : PARTICULARS Father / Guardian Mother / Guardian

Name

IC. No

Age

Race

Religion

Permanent Address

Correspondence Address

Occupation

Employer

Address of Employer

Monthly Salary

Telephone (House) : (Office) :

NAME OF SIBLINGS IN THE FAMILY :

No.

Name

Age

Marital Status

Occupation

Contact No.

3

EDUCATIONAL BACKGROUND :

No.

School / Institution

Duration of

Study

Highest

Qualification

Year

Obtained

Field of Study

MUET / TOEFL / IELTS Score : ___________________________ WORKING EXPERIENCE (if applicable) :

No.

Name of Employer

Address

Designation

Duration

DECLARATION OF STUDENT

I hereby declare that all information given is complete and correct. I understand that if there is any omission or negligent misstatement, the university shall have the right to reject my admission.

______________________ _____________________ Students Signature Date

4

APPENDIX B (1)

MEDICAL CERTIFICATION FORM

HEALTH EXAMINATION GUIDELINES FOR ENTRY INTO

MULTIMEDIA UNIVERSITY

1. Please read the instructions carefully before filling in the form.

2. This form has 4 sections: a. Section 1 (Part A and B) to be filled by the candidate; and b. Section 2, 3 and 4 to be filled by the examining doctor.

3. Please complete all the tests required in this form.

4. The university only accepts medical examination done within 60 days before registration or within

30 days after registration.

5. Chest X-ray done within 6 months prior to registration can be accepted.

6. Please keep the chest x-ray film for future verification, if required.

7. The university reserves the right to request full medical check-up or any specific laboratory tests should there be any doubt in the medical report submitted. All costs involved shall be borne by the candidate.

8. The university reserves the right to REJECT any application: a. Based on the results of the Health Examination; or b. Should there be any evidence that the applicant has given false information in the Health

Examination report or any supporting documents.

9. Before submission please make a photocopy of this Health Examination Report and all documents pertaining to this Health Examination for your own reference.

5

SECTION 1 (To be completed by candidate) Candidate must complete this form and hand it to the Medical Officer at the time of examination together with the offer letter.

(PART A) Student ID No.

IC No

Name

Programme

Date of Birth

Gender

Marital Status

Contact No

(PART B) Please tick () in the relevant box Declaration of self and family illness. Explain in full if you or your family has any of the following illness. * Immedidate family refers to father, mother, brothers and sisters; if married refers to spouse and children.

MEDICAL PROBLEMS

SELF IMMEDIATE FAMILY

If Yes please state

YES NO YES NO

1. Congenital or inherited disorder

2. Allergy

3. Mental illness

4. Fits, stroke, other neurological disease

5. Diabetes Mellitus

6. Hypertension

7. Heart or vascular disease

8. Asthma

9. Thyroid disease

10. Kidney disease

11. Cancer

12. Tuberculosis

13. Drug addiction

14. AIDS, HIV

15. History of surgery

16. Other illness

Current medication (Long term) (if applicable) ............................................................................................................................................................ ........................................................................................................................................................... I hereby declare that the information given above is true. I understand that my application will be rejected if there is any false information given. Students Signature : ____________________________ Date : _______________

6

SECTION 2 - PHYSICAL EXAMINATION (To be filled by examining doctor)

1. BASIC MEASUREMENT

HEIGHT : m

BLOOD PRESSURE : mmHg

WEIGHT : kg

PULSE RATE : / min

VISION TEST : Unaided: (R) _______ (L) _______ Aided : (R) _______ (L) _______

COLOR VISION TEST (including color blindness):

NORMAL / ABNORMAL* *Additional comment (if any):

2. GENERAL EXAMINATION

ITEM YES NO COMMENT

a. DEFORMITIES

b. PALLOR

c. CYANOSIS

d. JAUNDICE

e. OEDEMA

f. SKIN DISEASES

3. SYSTEMIC EXAMINATION

ITEM NORMAL ABNORMAL COMMENT

a. EYES (including funduscopy)

b. EARS

c. NOSE

d. ORAL CAVITY / THROAT

e. NECK

f. HEART

g. LUNGS

h. ABDOMEN / HERNIA ORIFICES

i. NERVOUS SYSTEM

j. MENTAL CONDITION

k. MUSCULOSKELETAL SYSTEM

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SECTION 3 - INVESTIGATIONS (To be filled by examining doctor)

URINE TEST

ITEM DATE TAKEN RESULT

a. ALBUMIN

b. SUGAR

c. MICROSCOPIC

d. MORPHINE

CHEST X-RAY INFORMATION

DATE TAKEN

PLACE TAKEN

REPORT

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SECTION 4 - CERTIFICATION BY THE EXAMINING DOCTOR Please tick () in the relevant box I certify that I have on this date _________________________________ examined Mr / Ms ___________________________________________________ IC No. ____________________________ and found him / her:- IN GOOD HEALTH AND IS FIT FOR ADMISSION INTO MULTIMEDIA UNIVERSITY HAVING THE FOLLOWING MEDICAL COMPLICATION(S) (Please specify) : ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ UNDERGOING TREATMENT FOR (Please specify) : ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Date: Signature of Doctor : Name of Doctor : Qualification : Hospital/Clinic : Official Stamp :

9

APPENDIX B (2)

FINANCIAL GUARANTEE FORM STUDENT ID NO. : .. PROGRAMME : ... GUARANTOR 1. I hereby agree to be the Guarantor of the student named : .. I.C No.

............. (Student) during the period of the Course (Name of Course) ...... at Multimedia University, Jalan Ayer Keroh Lama, 75450 Melaka / Multimedia University, Jalan Multimedia, 63100 Cyberjaya, Selangor. As the Guarantor, I hereby guarantee that I shall settle all outstanding debts incurred by Student and owing to Multimedia University (University) within the time specified. I also give my guarantee that Student, shall: (i) complete his/her course of study within the time specified by University and (ii) abide to the Constitution of University and its rules and regulations. If Student is found to have breached any rules or regulations, I agree to pay damages and/or compensation as demanded by University or further legal action can be taken against me.

2. My personal particulars are as follows :-

i. Name : .....

ii. I.C No./Passport No. :

iii. Occupation/Post : .....

iv. Office : .

Employers Address .

.............................................

v. Office Telephone No. :

vi. Home Address : ..............

................

vii. House Telephone No. :

viii. Monthly salary : (basic) ix. Total monthly income with allowances : x. Net Income after statutory and legal deductions :

xi. Properties

a. Land (size & value) :

b. House (s) (Values by licensed Valuer) :

c. Other properties such as shop etc. :

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Dependant :

Name of Dependant Age School Monthly Expenditure

1.

2.

3.

4.

5.

6.

I swear that all information given above is correct and true. If at any stage, any of the above information is found to be incorrect, the University authorities reserve the right to take any action against me. Yours faithfully Postal Address .. . Guarantors Signature

. . Permanent Address

Date : ..

Note : Those qualified to become Guarantor :-

1. Family members/Individual whose job is permanent and has a nett income of not less than RM1000.00 a month.

2. Financial Institution such as banks, and other government organizations.

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APPENDIX B (3)

STUDENTS DECLARATION FORM

(Note: Please read the contents carefully and make sure you understand what each paragraph means before signing it. This Declaration Form is a very important legal document and you should not sign it unless you agree with all the terms contained herein). 1. I understand and acknowledge that Multimedia University is the first private university where the

search of knowledge is for the pursuit of excellence and where the development of personality as well as leadership character is of paramount importance.

2. I solemnly promise to:

a) Uphold the ideals, philosophy and objectives of Multimedia University and lead a life of total commitment to the values of humanity, tolerance, honesty, hard work and good relationship with my fellows, colleagues, lecturers and University staff. I shall also co-operate in the promotion of an atmosphere of peace and orderly behaviour in and outside the University.

b) Abide by the Constitution, Statutes, Rules and Regulations including the Discipline of Students

Rules and other documents framed by the University Authorities from time to time. c) Maintain good behavior in my relationship with other people in the University and not to indulge

in the abuse of drugs, free immoral mixing of the sexes or any form of entertainment prejudicial to the good name of Multimedia University.

d) Respect the identity and way of life of the Muslims as well as the way of life of non-Muslim and

believers of other faiths both in and outside the campus, and not to do anything that would tarnish the good name of Multimedia University.

e) Observe decency and modesty in behavior without imitating, introducing any undesirable and

immoral trend or fashion. 3. I hereby declare that I accept as binding on me, as long as I am a student, all rules and regulations in

force at the time of joining and which might be framed subsequently. I shall submit to the discipline of the University as exercised through its lecturers and administrative officers.

4. I accept that the University shall have the right to reject my application without assigning any reason

whatsoever, if in the opinion of the appropriate authorities that my stay in the university is not conducive to my colleagues or welfare of others in Multimedia University.

5. The confirmation given in this Declaration Form is correct to the best of my knowledge and belief,

and in case of any misstatement or concealment of facts, the University shall have the right to refuse my admission or expel me from the University.

Students Signature : ID No. .. Students Name : ...

IC. No. : ... Date : ...

Note: Any negligent miss-statement shall result in the automatic cancellation of all concessions.

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APPENDIX B (4)

FINANCES DECLARATION FORM

(1) I agree and promise herewith to pay all fees owing to the University within the due date imposed, should my sponsor fails to settle them. I also agree to pay any late payment penalty or any other payment(s) related to the late payment as imposed by the University.

(2) I agree that the University shall have the right to deduct from any scholarship/financial aid(s) given to me in order to settle in part or all of any outstanding payments stated in (1) above.

(3) I agree that the University shall have the right to demand any outstanding payments stated above from my Guarantors in the event that I leave the University before the completion of my course of study.

(4) I also understand and agree that notwithstanding the completion or non-completion of my course of study, the University can and will pursue/demand any outstanding payments owing to the University after I have left the University. I agree that the University may engage any third party to collect on its behalf, any outstanding payments from me and thus I give my consent herewith for my relevant information to be disclosed to the said third party(s) by the University.

(5) I acknowledge and agree that the University has the right to revise its internal regulations including its fees structures, whenever deemed necessary, without any prior notification to be given. I agree to follow the revised/new regulations and fees accordingly.

(6) i) I acknowledge and agree that I am providing valid contact information to facilitate any transactions during and after the completion of my study and I will update the University should

there be any changes.

ii) If I do not claim for the refund of my deposit and any excess payment within one year from my completion date and upon notification by MMU to my updated address, I hereby consent to the said money to be given as (please tick the relevant box below) otherwise I agree that

the unclaimed deposit will be donated to the University.

Donation to the University,

Alumni,

Zakat,

Others, Please specify ____________________________________________

.

Signature of student

Name : .

IC No. : .

Date : ....

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APPENDIX C

STUDENTS PLEDGE STUDENT ID NO : ............................................ PROGRAMME : ...... I solemnly declare that during the period of my study at this university, a. I shall abide by the Law of the country; b. I shall abide by the rules and regulations of Multimedia University (Student discipline) and any other

rules and regulations amended and created; c. I shall protect the good name of the university at all time and look after the property and facilities from

being destroyed by me or anyone else; d. I shall not be involved in any undesirable activity that will interfere with the administration and/or

academic function of the University; and e. I shall devote to my studies and shall fulfill all educational conditions required.

Students Signature : ....

Name : .. IC No. : ... Date : ..