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Full Name*

(as in Identity Card)
Alias/Other Name

(if any)
Passport Number
Passport Expiry Date
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*
DD dash MM dash YYYY
Gender*
- Male
- Female
Dietary Requirement*
- Normal
- Halal
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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*
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Next-of-Kin (NOK) Information