borang tarik diri
DESCRIPTION
amik dr web uumTRANSCRIPT
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HEA/TD/2013
1. Nama/Name: ______________________________________________ 2. No. Matrik/Matric no.: _________________
2. Program/Programme: ______________________________________ 4. No.Telefon/Contact no.:_______________
5. No. Kad Pengenalan/ID. no.: _______________________________ 6. Sesi / Session : _________________________
7. Kursus yang dipohon / Course Requested(s):
Kod Kursus /
Course Code Kursus / Course Name
Jam Kredit /
Credit Hour (s)
Kump. /
Group
*Status /
Status
Pengesahan Pensyarah:
Tandatangan dan Cop /
Signature and Seal
Jumlah Jam Kredit /Total Credit Hours
*Nota/Note:
R: for Repair, U: for Audit
8. Jumlah Jam Kredit Yang Didaftarkan (sebelum permohonan) /
Total credits registered (before application):
9. Jumlah Jam Kredit Yang Digugurkan / Total credits hour(s) withdrew (TD):
10. Jumlah Jam Kredit Untuk Semester Ini (Selepas permohonan) /
Total credits for the semester (after application):
Perakuan pemohon dan pengesahan / Applicant Certification and Dean endorsement :
Saya mengaku bahawa maklumat yang dinyatakan di atas adalah benar. Saya faham bahawa sekiranya
maklumat yang disampaikan adalah tidak benar, saya akan dihadapkan ke Jawatankuasa Kecurangan
Akademik
I hereby certify that all the information given above is true. I understand that I will be referred to the Academic
Disciplinary Committee if the information given is false.
______________________________ _________________________________
Tandatangan Pelajar/ Tandatangan & Cop Dekan Pusat Pengajian /
Student signature Signature and Seal of Dean of School
Tarikh/Date:____________________ Tarikh/Date:____________________
UNTUK KEGUNAAN PEJABAT (U-Assist) / FOR OFFICE USE (U-Assist)
i. Tarikh terima permohonan / date of received an application: _________________________________________
ii. Disemak dan direkod oleh / Reviewed and recorded by:______________________________________________
iii. Status permohonan / Application status : _____________________________________________________________
UNIT PENGKULIAHAN
BORANG PERMOHOHAN TARIK DIRI (TD) KURSUS
APPLICATION FORM TO WITHDRAW (TD) THE COURSE