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Scroll and Transcript Collection Form

This document is an application form for a student to collect their scroll and official transcripts from the Convocation Session: MAC 2021. It contains sections for the student to provide their details such as name, student number, program, and address. The student can choose to either self-collect or have the documents posted. Supporting documents that need to be attached are also listed. If appointing a representative for collection, their details and signatures are required in a separate section. The final section is for office use only to record receipt and processing of the application.

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Syalmira Lovetobeloved
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35 views2 pages

Scroll and Transcript Collection Form

This document is an application form for a student to collect their scroll and official transcripts from the Convocation Session: MAC 2021. It contains sections for the student to provide their details such as name, student number, program, and address. The student can choose to either self-collect or have the documents posted. Supporting documents that need to be attached are also listed. If appointing a representative for collection, their details and signatures are required in a separate section. The final section is for office use only to record receipt and processing of the application.

Uploaded by

Syalmira Lovetobeloved
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

BRPK 1/2007 Pindaan Feb2021

Student Records and


Convocation Division (BRPK)
Registrar’s Office
Level 3, Menara Sultan Abdul Aziz Shah (SAAS)
Universiti Teknologi MARA
40450 Shah Alam Selangor, Malaysia
Tel: +603-55443130/3131 Fax: +603-55443111
E-mail : brpk@[Link]

APPLICATION FOR COLLECTION OF SCROLL AND OFFICIAL TRANSCRIPTS


CONVOCATION SESSION : MAC 2021
A. DETAILS OF GRADUAND

SYALMIRA BIINTI MOHD NASIR


Name : .....................................................................................................................................................
980220106154 2019695606
MyKad/Passport Number : ............................................... Student Number : .........................................
EC110
Program Code : ...........................
LOT 453 KG PANTAI SABAK, 16100 PENGKALAN CHEPA,
Correspondence Address : ......................................................................................................................
KOTA BHARU, KELANTAN.
...................................................................................................................
0135217331 syalmiramohdnasir@[Link]
Mobile Phone Number : .......................................... E-mail : ..................................................................
MAC 2021
Convocation Session : ........................................

Mode of Collection (please tick) :


Self collect at BRPK Counter

Post to correspondence address (Within Malaysia only)

Documents to be attached (please tick) :

A copy of MyKad/Passport Signature of


A copy of representative’s MyKad/Passport
A copy of Graduates Tracer Study confirmation slip
A copy of receipt for convocation fee
A copy of receipt for payment of arrears (If any)

Graduand : .............................................................. Date : ..............................................


11 August 2021

B. GRADUAND’S CONSENT (If appointing a representative)

I hereby appoint the below mentioned name as my representative to collect the scroll and official transcripts on my behalf. I
acknowledge that Universiti Teknologi MARA will not be held responsible for any claims should the document is damaged or
lost. I take full responsibility for my actions.

Signature of Graduand : .............................................................. Date : ..............................................

C. DETAILS OF REPRESENTATIVE

Name : ......................................................................................................................................................
MyKad/Passport Number : ............................................. Relationship : ................................................

Signature of Representative : ...................................................... Date : ..............................................

FOR OFFICE USE ONLY

Received by : ................................................ Processed by : .........................................................


Date : ................................................ Date : .........................................................

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