Please complete the details below
Name of Programme
Intake
Section A - Student Particulars
Full Name(per NRIC/Passport)
NRIC/Passport No.
Passport Expiry Date (for foreign students only) (dd/mm/yyyy) 01020304050607080910111213141516171819202122232425262728293031 JanFebMarAprMayJunJulAugSepOctNovDec 2008200920102011201220132014201520162017201820192020
Date of Birth (dd/mm/yyyy) 01020304050607080910111213141516171819202122232425262728293031 JanFebMarAprMayJunJulAugSepOctNovDec 200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119401949194819471946194519441943194219411930193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111900190919081907190619051904190319021901
Age
Sex Male Female
Nationality Malaysian Non Malaysian Others (please specify)
Race Malay Chinese Indian Others (please specify)
Status Bumiputera Non-Bumiputera
Resident Details
Home Address
Postcode
State
Country
Tel
Fax
Email (required)
Same as home address Yes No
Correspondence Address
H/P
Email
Section B - Parent/Guardian/Sponsor Particulars (if applicable)
Name of Father/Mother/Guardian/Sponsor (per NRIC/Passport)
Occupation
Section C - Qualifications
School/Institution/University - Qualification - From - To
Section D - Work Experience (if any)
Company - Position - From - To
Section E - Supporting Documents
Following documents are needed.
2 copies (6 copies for Foreign Student) of coloured passport-sized photographs
1 copy of Student identification card
3 copies of passports of Foreign Student (include blank pages)
1 certified true copy of academic certificate/transcript for the following qualification
Section F - Declarations
I declare that the information provided by me in connection with this application is true and correct. I undertake to inform Life College immediately of any change in address, phone number and other information provided by me in this application. I understand that Life College reserves the right to vary or reverse any decision regarding admission or enrolment made on the basis of incorrect or incomplete information. I agree to be bound by the Terms and Conditions of the offer to study at Life College (available upon request).
