APPLICATION FORM

PLEASE READ AND UNDERSTAND THE INSTRUCTIONS BEFORE SUBMITTING THIS APPLICATION

INSTRUCTIONS

Please use this form to provide Tridiva Utama Sdn Bhd with information to support your application for admission. A screen with the information that you have furnished will be made available for checking. Please click on the BACK button to go back to the previous page for any amendment. Should there be no amendment needed, please proceed by clicking on the SUBMIT button to save and submit the information.

Do not submit more than ONE application form.

Should you need further information, please contact us.
 
PERSONAL PARTICULARS
Name:
Address:
Town/City:
State:
Postcode:
Country:
Marital Status: Date of Birth:
Gender: Passport/IC No:
Phone No: Email Address:
Nationality:
Religion:
Parent Occupation:
CHOICE OF COURSES
1st Choice
Course:
2nd Choice
Course
3rd Choice
Course
EDUCATIONAL BACKGROUND
School / College

Date Attended
Examination

Date
No

Name & Location
From (dd/mm/yyyy)
To (dd/mm/yyyy)
Certificate/Diploma
Received (dd/mm/yyyy)
(1)
(2)
(3)
(4)
(5)
STPM / A-LEVEL / MATRICULATION / FOUNDATION / EQUIVALENT RESULTS
Qualification
CGPA/Grade
SPM / O-LEVEL / EQUIVALENT RESULTS
No
Subject
Grade
(1)
Biology
(2)
Chemistry
(3)
Physics
(4)
Maths
(5)
Add Maths
ENGLISH LANGUAGE PROFICIENCY
TOEFL : IELTS: MUET:
DECLARATION

PLEASE READ THE FOLLOWING DECLARATION AND INDICATE ACCEPTANCE OF THE CONDITIONS:

I declare that the information supplied in this application is correct and complete. I understand that this application form will only help Tridiva Utama Sdn Bhd in providing guidance and advice towards my future application. Tridiva Utama Sdn Bhd reserves the right to request any additional information before a decision of admission is made. I, the undersigned, declare that the information given in this application form is complete, accurate and true, and I agree to abide to all policies and regulations of Tridiva Utama Sdn Bhd. I understand that any information given falsely or withheld will affect the decision of my application, and may result in my ineligibility for admission or enrolment for a particular institution.

I do hereby declare that the information submitted is true to the best of my knowledge:
Name :
Date (dd/mm/yyyy) :