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PAGE

CHECKLIST

FOR UNDERGRADUATE APPLICATION FORM

Please submit all the following items along with the Undergraduate Application Form or Online ApplicatForm to ensure tha t your app lic a tion is CO MPLETE and c an be p roc essed for ad mission. Please tic k (/) in ap propriate bo xes to indica te items that have b een a ttac hed.

Non-refund ab le ap p lic a tion proc essing fee o f US$ 25.00 in the fo rm o f ba nk draft payab leto Financ e

Director, International Islamic University Malaysia (applicable to international applicantsresiding outside Malaysia) or RM 75.00 in the form of either Malaysian money order or postal

orde r pa yab le to the Financ e Direc tor, Internat iona l Islamic University Ma laysia (app lic ab leto a pp lica nts who submit ap p lic a tion forms in Ma laysia);

. Ce rtified c op ies (certific a tion should be ce rtified by authorized office r a t the Ministry ofEduc a tion OR authorized law p rac titione r) of Higher Sc hoo l Certific a te (HSC) / GCE ALeve l or any o ther equivalent c ertific a tes;

i. 3 c op ies of internationa l passport boo k with a t least 2 yea rs va lid ity (For InternationalAp p lic ants only);

v. 4 rec ent passport-sized , c olored photo grap hs;

. Financ ial Sta tem ent and / or Und ertaking letter from self/p a rent/ guard ian/ sponsor;

i. University Entranc e Exam (only c om pulsory for c ountries which req uire to pass the Entranc eExam for en try into the University in their respec tive c ountries);

ii. SAT 1 result (on ly c om pulsory for Inte rna tiona l sc hools which follow s the Am erica ned uca tion system )

Upon completion, this form should b e returned to (post/ ema il/ by hand):

Ad missions and Rec ords Division (A & R)

Internationa l Islam ic University Malaysia, Jalan Gomb ak ,

P.O Box 10

50728 Kuala Lumpur, MALAYSIA

Fax: 603-6196 4724 Email: ad missions@iiu.ed u.my

URL: http:/ / www.iiu.ed u.my/ anr

Any enq uiry, c ontac t: 603-6196 4000 (ext: 3024/ 3022)

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UNDERGRADUATE APPLICATION FORMCHOICE OF PROGRAMME OF STUDY

1st Choice:* 2nd Choice:*

PERSONAL DETAILSName as stated in the I/C / Passport (in capital letters):* Gender:

Male

Name to appear in the Student Card: (Maximum 9 characters) Female

Citizenship:* Date of Birth:* Age: Marital Status:

Single Married Others: __________

Identity Card/

International Passport No.:*

Date of Expiry: Date & Place of Issue: Country/State of Origin:

Country of Residence: Religion:* Denomination/Madzhab:* Ethnic Origin (Malaysian only)

Postal Address:*

Street:

Post / Zip Code:

City/

State:Country:

Telephone No.:* Fax. No.: E-mail Address:*

Permanent Address (If different from the above):

Street:

Post / Zip Code:

City/

State:Country:

Telephone No.: Fax. No.:

A. FAMILY DETAILSName of Father/Guardian:* Identity Card/Passport No.: Citizenship:*

Occupation:* Monthly Income:*

(USD or RM)

No. of Dependants: Telephone No.:

Fax. No.:

E-mail Address:

Address:

For Office Use Only: Reference No: Processing FeeDate Received:

Country Code:

Admission Qualification: Date of Verification:

PHOTO

(4 copies one

of them to be

pasted here)

UG

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PAGE 3ADDITIONAL INFORMATION

i.Have you ever studied in any institution of higher learning?Yes (If Yes, please fill in this Section) No

ii.Name and Address of the institution(s):

iii. Reasons for leaving:

Study/Course completed Dismissed Withdrew Others

If Others, please state:

B. DECLARATIONI hereby attest that I havepersonally filled in this Application Form and the information contained herein is complete and

accurate to the best of my knowledge. I understand that withholding or giving false information will make me ineligible fo

admission and future enrollment. I further understand that I may be required to appear for an interview or to undergo such

test as requested by the University Board of Admission as a condition for admission to the programme of study for which

have applied.

Applicants Signature:* Date:

* Required. Failure to fill in this column may result in your application being rejected.

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(Required for Student Visa)

Instruction: You are required to complete this form and submit it together with your application for admission. Your application

package will not be processed without this financial statement.

Applicant's Name: ______________________________________ Ref. No (if any): ______________

In the name of Allah, I solemnly declare that:

I am able to pay the tuition fee in full and all other payments as required by IIUM throughout my studies. I am

also able to finance the living expenses of myself and my family (if any and if they are permitted by Malaysian

Immigration to accompany me).

I attached herewith undertaking letter and income tax statement/salary slip/bank statement of

myself/my parent/guardian.

Applicant's signature: _______________________ Date: ______________________

If you are sponsored, please have your sponsor fill out and sign the following:

Name of Organization/Institution/Sponsor: ___________________________________________________

Address: ______________________________________________________________________________

______________________________________________________________________________

Phone: ______________________________ Fax: ___________________________

Contact Person Name: ____________________________ Position: _______________________________

Relationship of sponsor to applicant: ________________________________________ ________________

I hereby agree to sponsor the student for the length of his/her Undergraduate program at

International Islamic University Malaysia (IIUM).

Signature: _______________________ Date: _____________________

(Original signature required. Fax/scan copies are not accepted)

International Applicant's Financial Certification