*PTPL Branch :
Online Application Form for *Session : *Year :
Area of studies
*First Choice :
*Second Choice :
*Third Choice :

Personal Details
*Name : Religion :
*Identity Card : *Date of Birth :
Race : *Gender :
*Marital Status :      
*Postal Address : *Permanent Address :
       
*Postcode : *Postcode :
*State : *State :
*Mobile Number : *Telephone Number :
*Email : Facebook URL :
      Twitter :

  Contact person in case of emergency
*Parents / Guardian's name : *Name :
*Identity Card : *Address :
*Occupation :    
*Monthly income : RM *Postcode :
*Number of dependent : *State :
*Address : *Telephone Number :
         
*Postcode :      
*State :      
*Mobile Number :      
Email :      
 
Qualifications Completed and Held
*School State :
*School District :
*School Name :
Academic Qualifications: SPM / SPMV /O Level *Year Aggregate:
Mandatory Subject   Grade Other Subject   Grade
Bahasa Melayu : :
Bahasa Inggeris : :
Sejarah : :
Matematik : :
Pengetahuan Agama Islam : :
*Please ensure that you have key in all off your SPM result    
Employment Details
  Occupation Level Employer Year
1.
2.
 
Sponsor Particular
Particulars of the applicant's sponsor (person / organisation responsible for payment of all fees).
Name
:   IC/Passport Number :
Correspondence Address :   Relationship :
:   Telephone :
State :        
Postcode :        
 
Hostel Accomodation
Do you want hostel accomodation ?
Yes No
 
Medical History
Please indicate if you have ever suffered from or experienced or received treatment for the following diseases and condition :
Bronchial Asthma Yes No Diabetes Mellitus Yes No Psychiatric Illness Yes No
Hypertension Yes No Heart Diseases Yes No HIV / AIDS Yes No
Hearing Problem Yes No Kidney Diseases Yes No Others

Submit Application
I declare the information provided in connection with this application is true and correct. I understand that MSU reserves the right to vary or reserves any decision regarding admission or enrolment made on the basis of incomplete information. I also agree to abide by all MSU rules and regulations.

Verification