REGISTRATION FORM

PART A. PERSONAL DETAILS

Registration No: ONAPP/UndergraduateJun/201522120
Title : MS.
1. Name: (as in NRIC / Passport)
HAMUTHAMALAR A/P S. RENGASAMY
2. NRIC (Malaysia Identity Card No.)
970319106788
3. Date of Birth

4. Nationality

19-03-1997

MALAYSIA

5. Gender

6. Marital Status

FEMALE

SINGLE

7. Race

8. Religion

INDIAN

HINDU

9. Postal Address
NO 21 , JALAN SERI SEDELI 6
TAMAN SRI ANDALAS
City: KLANG
Postcode: 41200

State: SELANGOR DARUL EHSAN

10. Telephone
Mobile:

Home: 0102781922

11. Email
hamutha_malar19@hotmail.com

PART B. DETAILS OF PARENT / GUARDIAN

1. Name
S.RENGASAMY A/L SUPPIAH
2. Relationship
FATHER

Country: MALAYSIA

3. NRIC (Malaysia Identity Card No) / Passport No.

600702105245
4. Occupation

5.

PURCHASING OFFICER

Salary Range

1000 - 2500

6. Postal Address
NO 21, JALAN SERI SEDELI 6 ,
TAMAN SRI ANDALAS
City: KLANG
Postcode: 41200

State: SELANGOR DARUL EHSAN

Country: MALAYSIA

7. Telephone
Home: 0102781922

Office:

0351612000

Mobile:

0123855051

8. Employer's Address
City: N/A
Postcode:

State: SELANGOR DARUL EHSAN

CONTACT PERSON IN CASE OF EMERGENCY (other than the above)

1. Name
S.RENGASAMY A/L SUPPIAH
2. Relationship
FATHER
3. NRIC (Malaysia Identity Card No) / Passport No.
600702105245
4. Postal Address
NO 21, JALAN SERI SEDELI 6 ,, TAMAN SRI ANDALAS , KLANG, 41200,
SELANGOR DARUL EHSAN, MALAYSIA
5. Telephone
Home: 0102781922
Office: 0351612000
Mobile: 0123855051

PART C. SPONSOR PARTICULAR

Are you financially sponsored by organization/agency? YES
Name : PTPTN
Amount :

Country: MALAYSIA

PART D. PROGRAM APPLICATION

1. State the details of programme you wish to register into.
Programme Name: FOUNDATION PROGRAMME IN MANAGEMENT
Faculty: Please contact admission staff for more info
Entry Qualification: SPM / SPMV
2. Details of your educational background
SPM / O Level / equivalent result
Subject

Grade

Bahasa Melayu

Bahasa Inggeris

Mathematics

Basic Economics

Science

History

Pendidikan Moral

Perdagangan

Teknologi Maklumat A3. Enclosed herewith:

(i)

3 recent passport size photographs;

(ii)

Certified true copy of my personal identification, other letter and academic qualifications;

PART E. WORKING EXPERIENCE

Are you currently working? No

PART F. DECLARATION AS TO FITNESS

I don't have any disability that requires special attention.

PART G. STUDENT DECLARATION AND OATH

1.
(i).

I sincerely declare that:

I am of legal age, of sound mind and qualified to form a binding contract and not a person barred from receiving

services under the laws of Malaysia or other applicable jurisdiction.

(ii).

I agree to: (a) provide true, accurate, current and complete information about myself as prompted by this registration

form and (b) maintain and promptly update the registration data to keep it true, accurate, current and complete. If any
information I proved is untrue, inaccurate, not current or incomplete, or the University has reasonable grounds to suspect that
such information is untrue, inaccurate, not current or incomplete, the University has the right to reject my application into the
University or suspend or terminate my enrolment as student of the University and refuse any and all current or future use of
service of the University without prejudice to the University`s right accrued before such suspension or termination.
2.

I solemnly promise during the period of my study at this University that:

(i).

I shall abide by the laws of this country;

(ii).

I shall abide by the rules and regulations of the University, the student discipline rules and any other rules and

regulations in force or made from time to time;

(iii). I shall uphold to good name of the University at all times and be equally responsible to protect the property and facilities
oh the University from being damaged or destroyed by me or anyone else;
(iv).

I shall not be involved in any undesirable activity that will interfere with the administrative and/or academic function of

the University;
(v).

I shall devote my time to be active in my studies and shall fulfill all educational conditions required; and

(vi).

I shall not to do any act whether directly or indirectly that shall infringe the intellectual property right or the copyright

of the University and/or any other third party and I shall not disclose any confidential information relating to the University
during my study at the University and thereafter.
3.

I hereby agree to terms and conditions set forth by UNITAR.

4.

I hereby agree with UNITAR privacy policy terms.

5.

I hereby consent to the collection, use, access,transfer, storage and processing of my personal data as describe in

UNITAR Privacy Policy Notice.

______________________
Signature
Name: HAMUTHAMALAR A/P S. RENGASAMY
NRIC No: 970319106788
Date: 29-09-2015