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Online Registration Form

Section 1: Programme Applied
Date of Intake *
Programme Applied *
Locality *
Qualification *
Contact Person *
Loan PTPTN *
Hostel Accomodation *
Section 2: Personal Biodata
Name *
NRIC/Passport No. *
(example: 900425-14-5792 / A1234567)
Nationality *
Religion *
Gender *
Marital Status *
Race *
Date of Birth *
Age *
Physical Disability - if any
Spouse Name - if married
Telephone No. *
(example: 012-3456789 / 03-61898908)
Correspondence Address
Postcode/Zipcode
State
Country
Email Address *
(example: johndoe@yahoo.com)
(Applicant required to fill in the correct e-mail address. The offer letter will be sent to your e-mail)
Section 3: Academic Background
Type of Examination *
Year
No. of Credit

(INFORMATION ON SPM / O-LEVEL)
No. of Principal STPM

(INFORMATION ON STPM)
No. of Credit for A-Level

(INFORMATION ON A-LEVEL)
Diploma CGPA

(INFORMATION ON DIPLOMA)
Others

(INFORMATION ON STPM / A-LEVEL / DIPLOMA)
List of Subjects and Grades
(Please fill up according to your exam result)
Section 4: Parents/Guardians Details
Parents/Guardians Name*
NRIC/Passport No.*
(example: 900425-14-5792 / A1234567)
Relationship with Applicant
Occupation
Family Income
Handphone No.
(example: 012-3456789)
House Phone No.
(example: 03-61898908)
Email Address
(example: johndoe@yahoo.com)
Section 5: Declaration
I hereby declare that the information contained herein is complete and accurate to the best of my knowledge. I fully understand that withholding or giving false information, the KLMUC has the right to reject or revoke my application or terminate my studies at any time. I hereby allow the KLMUC management to use my data for education purposes only.

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