registration document october 2014

8/10/2019 Registration Document October 2014

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REGISTRATION

DOCUMENT

October 2014 Intake

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)StudentsDeclaration Form

Appendix B(4)FinancesDeclaration Form

Appendix C Students Pledge

Kindly complete and submit thisdocument on the scheduledorientation 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.


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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.


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EDUCATIONAL BACKGROUND :

No. School / Institution Duration ofStudy

HighestQualification

YearObtained

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 omissionor negligent misstatement, the university shall have the right to reject my admission.

______________________ _____________________StudentsSignature Date


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APPENDIX B (1)

MEDICAL CERTIFICATION FORM

HEALTH EXAMINATION GUIDELINESFOR 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; andb. 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 within30 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 testsshould there be any doubt in the medical report submitted. All costs involved shall be borne by thecandidate.

8. The university reserves the right to REJECT any application:a. Based on the results of the Health Examination; orb. 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 documentspertaining to this Health Examination for your own reference.


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

MEDICAL PROBLEMSSELF IMMEDIATE

FAMILY If Yes please stateYES 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. Asthma9. 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 ifthere is any false information given.

Students Signature : ____________________________ Date : _______________


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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 EXAMINATIONITEM 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 :


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APPENDIX B (2)

FINANCIAL GUARANTEE FORM

STUDENT ID NO. : ..PROGRAMME : ...

GUARANTOR1. 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 AyerKeroh 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 andowing 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 havebreached any rules or regulations, I agree to pay damages and/or compensation as demanded byUniversity 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 afterstatutory and legaldeductions :

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 MonthlyExpenditure

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 isfound 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 amonth.

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


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APPENDIX B (3)

STUDENTSDECLARATION FORM

(Note: Please read the contents carefully and make sure you understand what each paragraph meansbefore signing it. This Declaration Form is a very important legal document and you should not sign itunless you agree with all the terms contained herein).

1. I understand and acknowledge that Multimedia University is the first private university where thesearch of knowledge is for the pursuit of excellence and where the development of personality aswell 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 relationshipwith 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 StudentsRules 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 indulgein the abuse of drugs, free immoral mixing of the sexes or any form of entertainment prejudicialto 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 andbelievers of other faiths both in and outside the campus, and not to do anything that wouldtarnish the good name of Multimedia University.

e) Observe decency and modesty in behavior without imitating, introducing any undesirable andimmoral 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 inforce at the time of joining and which might be framed subsequently. I shall submit to the discipline ofthe 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 reasonwhatsoever, if in the opinion of the appropriate authorities that my stay in the university is notconducive 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 refusemy 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)

FINANCESDECLARATION 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 otherpayment(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) givento 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 abovefrom my Guarantors in the event that I leave the University before the completion of my course ofstudy.

(4) I also understand and agree that notwithstanding the completion or non-completion of my course ofstudy, the University can and will pursue/demand any outstanding payments owing to the Universityafter I have left the University. I agree that the University may engage any third party to collect onits behalf, any outstanding payments from me and thus I give my consent herewith for my relevantinformation 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 includingits fees structures, whenever deemed necessary, without any prior notification to be given. I agreeto 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 shouldthere be any changes.

ii) If I do not claim for the refund of my deposit and any excess payment within one year from mycompletion date and upon notification by MMU to my updated address, I hereby consent to thesaid money to be given as (please tick the relevant box below) otherwise I agree thatthe 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 otherrules 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 frombeing destroyed by me or anyone else;

d. I shall not be involved in any undesirable activity that will interfere with the administration and/oracademic 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 : ..

registration document october 2014

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