8/11/2019 2013 SUN-U Completion Withdrawal Form (05022013)

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COMPLETION/WITHDRAWAL FORMCESSATION OF STUDY AND APPLICATION FOR REFUND OF DEPOSITS

PERSONAL AND PROGRAMME PARTICULARS

Name

NRIC/Passport No. Student ID

Contacts Tel No.

Email Address

Mobile Phone No.

Programme Intake

COMPLETION/WITHDRAWAL PARTICULARS

IMPORTANT NOTES AND MANDATORY DECLARATION

Signature of student

Date

Please read the following carefully and sign and date here before submitting this form.

I hereby undertake that I am fully aware of and will be bound by the Sunway University

rules and regulations for this application.

I declare that all the particulars relate to me and are correct.

1. Application for refund must be made within 12 calendar months from your last day of

study.

2. The return of your student ID card is mandatory if one has been issued to you, and

also your library card (if you have registered as a student in 2008 or earlier), failing

which a penalty of RM50.00 and RM25.00 will be imposed respectively.

3. All Sunway University equipment/property in your possession (e.g., books borrowed

from the Tun Hussein Onn Library) must be returned to the relevant departments.4. Please submit this form to the:

Registry(Malaysian Student) or International Office(International Student)

Name

SUPPORTING DOCUMENTATION

I enclose herewith a letter/copy of air-ticket/other supporting document(s) for this

application.

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Completion Seek employment Further study Others

Please state your plan after completing the programme stated above.

Withdrawal Financial

Academic

Please state the reason for withdrawing from your programme.

Medical

Seek employment

Others

Please state programme Please state plan

Please state name of institution

Please state reason

REFUND PARTICULARS (IF APPLICABLE)

Please specify the payment option for refund (subject to bank charges)

By cheque

By bankdraft

By telegraphic transfer

Crossed cheque Open cheque

Currency

Currency SWIFT code

Bank

Account no.

Please state name, branch and country

Please specify the payee for refund

Self

Family member Father Mother Guardian (as specified in your application form)

Name NRIC/Passport no.

Please specify the collection method for refund (Note: Not applicable for telegraphic transfer)

Collect personally or by the payee

Collect on behalf of payee (Note: A letter of authorisation is required)

(unable to cope with programme)

As in NRIC/Passport.

Please complete all sections on this form in BLOCK C PIT LS.

(Version: 05022013)

Please provide full address. (Note: overseas address using P.O. Box is not allowed)

Post by mail

Transfer to other institution

8/11/2019 2013 SUN-U Completion Withdrawal Form (05022013)

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TERMS AND CONDITIONS

Eligibility criteria

You are eligible to apply for refund of deposits if:

You do not have any outstanding payment with Sunway University.

You are fully aware and accept that you will comply with the rules and regulations of Sunway University for the refund of deposits.

Processing time

The processing time of this application will take approximately 20 working days from the date of release of the final semester results

(excluding Saturday, Sunday and public holidays) and/or confirmation of completion of programme.

For enquiries please call +603 7491 8622

Malaysian student: Extension 8772/8179 (for all programmes)

International student: Extension 3863 (for all programmes)

Or send an email to registry@sunway.edu.my (please provide your name as in NRIC/Passport, student ID number, programme and intake).

Data protection

The protection of personal privacy is an important concern to Sunway University, and any personal data collected on this form will be

treated in accordance with the current data protection policies of the institution. 2

FOR OFFICE USE ONLY

* For students who are enrolled in the Intensive English Programme and one other programme.

Verification from School / Academic Department

INTERNATIONAL OFFICE

Cancelled student ID card

Cancelled library card

Verified passport (for cancellation of student pass)

Received a copy of the passport information page

Received a copy of the passport entry stamp/offer letter

Signature

Date

Name

Signature

Date

Name

THE REGISTRY

Cancelled student ID card

Cancelled library card

Updated student and programme/subject statuses (in the EMS)

Printed and issued letter of notification

Remarks Remarks

Approval from Centre for English Language Studies (if applicable*)

Signature

Date

Name

Position

Signature

Date

Name

Position

Remarks Remarks

Signature

Date

Name

Position and Department

Remarks

Acknowledgement by interviewer (only required if interview is not conducted by School/Academic Department)

This section must be endorsed by a senior staff member from the relevant School or Academic Department.

Note: Remarks in this section will be considered as official and entered into EMS