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World of Technology

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SLIP PERMOHONAN KEMASUKAN KE IPTA / POLITEKNIK PREMIER PROGRAM PENGAJIAN LEPASAN SPM/SETARAF SESI AKADEMIK 2013/2014 KATEGORI A

9504181360874

Tarikh & Masa Permohonan : 21 Mar 2013 09:43:33 AM Transaksi Terakhir anda pada 21 Mar 2013 09:35:38 AM

Rujukan Permohonan : ASPM160462210320136087 Baki Kemaskini : 3

Permohonan anda telah SELAMAT DITERIMA OLEH SISTEM dan akan diproses. Anda telah mengemukakan permohonan kemasukan ke IPTA/ Politeknik Premier bagi Program Pengajian Lepasan SPM/Setaraf Sesi Akademik 2013/2014
A. Maklumat Pilihan Program 01. Pilihan Program Pengajian Mengikut Keutamaan : PILIHAN Pilihan 1 Pilihan 2 Pilihan 3 Pilihan 4 Pilihan 5 Pilihan 6 Pilihan 7 Pilihan 8 02. Pilihan Bidang Mengikut Keutamaan Bidang 1 : FARMASI Bidang 2 : SAINS KESIHATAN/ SAINS BERSEKUTU Bidang 3 : PERGIGIAN 03. Adakah anda bersetuju menerima tawaran selain pilihan anda di atas? : TIDAK B. Maklumat Peribadi 04. No. Kad Pengenalan/MyKAD 05. No. Kad Pengenalan/MyKAD a. Pemohon b. Bapa/ Penjaga c. Ibu 06. Nama 07. Tarikh Lahir 08. Tempat Lahir 09. Alamat Surat - Menyurat 10. Bandar 11. Poskod 12. Negeri 13. No. Telefon Rumah 14. No. Telefon Bimbit 15. Emel 16. Taraf Perkahwinan 17. Kecacatan a. Adakah anda cacat? b. Jika YA, Sila Pilih c. Jika CACAT LAIN, Sila Nyatakan d. No. Pendaftaran OKU (jika ada) e. Keterangan Cacat (jika ada) : 950418136087 (Semasa pendaftaran peperiksaan) : 950418136087 : 640219135539 : 651029135494 : ANDY LAU SIE PING : 18-04-1995 : SARAWAK : LOT1460,LORONG DESA SENADIN,1C-1,98000, MIRI,SARAWAK : MIRI : 98000 : SARAWAK : 085555574401 : 0148865333 : deadgod95@hotmail.com : BUJANG - TIDAK KOD Q0080 Q0070 A2000 E2060 TAMHIDI PERUBATAN TAMHIDI PERGIGIAN DIPLOMA SAINS DIPLOMA FARMASI (TERBUKA KEPADA BUMIPUTERA SAHAJA) PROGRAM PENGAJIAN IPTA/POLITEKNIK USIM USIM UPSI UiTM

C. Maklumat Pekerjaan & Pendapatan Keluarga 18. Status Pekerjaan a. Bapa / Penjaga : LAIN-LAIN BIDANG Sektor : SWASTA b. Ibu : TIDAK BEKERJA/ TIADA PEKERJAAN / MENGANGGUR c. Pemohon : TIDAK BEKERJA/ TIADA PEKERJAAN / MENGANGGUR 19. Tempoh Pengalaman Kerja Pemohon TIADA PENGALAMAN BEKERJA : 20. Pendapatan Keluarga : RM2001-RM3000 21. Tanggungan Keluarga : 5 ORANG 22. Tempat Tinggal : BANDAR 23. No. Rujukan Cukai Pendapatan : Bapa/Ibu/Penjaga D. Maklumat Akademik 24. Kelayakan Pemohon 25. Jenis Sekolah 26. Kod Sekolah 27. Angka Gilir SPM 28. Tahun SPM : SPM : SEKOLAH MENENGAH KEBANGSAAN HARIAN(SMK) : SM046 : SM046A037 : 2012

Sektor : TIADA Sektor : TIADA

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SLIP PERMOHONAN KEMASUKAN KE IPTA / POLITEKNIK PREMIER PROGRAM PENGAJIAN LEPASAN SPM/SETARAF SESI AKADEMIK 2013/2014 KATEGORI A

9504181360874

Tarikh & Masa Permohonan : 21 Mar 2013 09:43:33 AM Transaksi Terakhir anda pada 21 Mar 2013 09:35:38 AM

Rujukan Permohonan : ASPM160462210320136087 Baki Kemaskini : 3

Permohonan anda telah SELAMAT DITERIMA OLEH SISTEM dan akan diproses. Anda telah mengemukakan permohonan kemasukan ke IPTA/ Politeknik Premier bagi Program Pengajian Lepasan SPM/Setaraf Sesi Akademik 2013/2014

E. Maklumat Kokurikulum 29. CGPA Kokurikulum 30. Sukan / Permainan a. Jenis b. Jawatan c. Tahap Penglibatan d. Jenis Kejohonan 31. Badan Beruniform a. Jenis b. Jawatan c. Penganugerahan Sijil 32. Kelab / Persatuan a. Jenis b. Jawatan c. Tahap Penglibatan F. Lain-lain Maklumat Tambahan 33. Adakah anda bersetuju untuk menerima sebarang hebahan maklumat melalui Sistem Pesanan Ringkas(SMS). 34. Adakah anda bersetuju maklumat permohonan ini dikemukakan kepada pihak lain untuk tujuan pendidikan tinggi negara? 35. Adakah anda bersetuju untuk menerima Wang Pinjaman Pendahuluan (WPP) PTPTN? 36. Adakah anda mengemukakan permohonan ke agensi lain selain BPKP ? : YA : TIDAK : YA : TIDAK : 3.17 : BADMINTON : AHLI BIASA RUMAH SUKAN/KELAS/RUMAH ASRAMA : TIDAK MENGAMBIL BAHAGIAN : TIDAK TERLIBAT : PERSATUAN BULAN SABIT MERAH : AHLI BIASA UNIT BERUNIFORM/KONSTABEL/PREBET : PERSATUAN BULAN SABIT MERAH : TIDAK TERLIBAT DALAM AKTIVITI : AHLI BIASA : TIDAK MENGAMBIL BAHAGIAN

Peringatan
Sila pastikan anda mencetak Jawapan Penerimaan Permohonan & Maklumat Permohonan (Menu SEMAKAN) sebagai rujukan permohonan. Semakan boleh dibuat di laman SEMAKAN dalam tempoh 7 hari selepas permohonan ditutup melalui laman web http://upu.mohe.gov.my

Perakuan Pemohon Saya mengaku bahawa maklumat yang diberikan adalah benar. Pihak IPTA dan Kementerian Pengajian Tinggi Malaysia berhak menolak permohonan ini atau, dan membatalkan tawaran pada bila-bila masa sekiranya keterangan yang saya kemukakan adalah tidak benar.

Sebarang pertanyaan sila hubungi :

Pengarah Bahagian Pengurusan Kemasukan Pelajar Jabatan Pengajian Tinggi Kementerian Pengajian Tinggi Malaysia Aras 4, No. 2, Menara 2, Jalan P5/6, Presint 5 62200 PUTRAJAYA Hotline UPU 1: 03-8870 6767 Hotline UPU 2: 03-8870 6777 No. Faks : 03-8870 6864 Emel : upu@mohe.gov.my

NOTA : Janaan komputer, tandatangan tidak diperlukan.

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