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Full Name*
(as in Identity Card)
Alias/Other Name
(if any)
Passport Number
Passport Expiry Date
Date Format: DD dash MM dash YYYY

(dd-mm-yyyy) eg. 01-01-1999"
IC Number*
(781111031234)
Date of Birth (dd-mm-yyyy) e.g. 01-01-1990*
Date Format: DD dash MM dash YYYY
Gender*
- Male
- Female
Dietary Requirement*
- Normal
- Halal
- Vegetarian
Home Contact No. (include Country Code)*
Address*
Email*
Next-of-Kin (NOK) Information
NOK Name*
(NOK) Relationship*
(NOK) Contact No*
(NOK) Email*
SPM / UEC Grades
Highest Qualification*
Year of SPM/UEC obtained (Students taking SPM this year, kindly input 2019)*
English
Math
Science
Science Subject Name*
2 Other Best Subjects (Excluding Moral Education and Art)
Best Subject 1 Score
Best Subject 1 Name (in English)*
Best Subject 2 Score
Best Subject 2 Name (in English)*
State of School/College where you obtained the above results*
Consent*
I have read and agree to the website terms and conditions
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I declare that the information provided by me on the above form is true and correct to the best of my knowledge and belief.
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Next-of-Kin (NOK) Information