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Application for UITM Scroll Collection

This document contains an application form for graduates of Universiti Teknologi MARA to collect their scroll and official transcripts from the Student Records and Convocation Division. Section A requests details of the graduate such as name, student number, program, and address. Section B is for graduates appointing a representative to collect the documents on their behalf. Section C collects details of the representative. The form requires signatures of the graduate and representative, as well as copies of identification documents and receipts.

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Adilah Azam
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65 views1 page

Application for UITM Scroll Collection

This document contains an application form for graduates of Universiti Teknologi MARA to collect their scroll and official transcripts from the Student Records and Convocation Division. Section A requests details of the graduate such as name, student number, program, and address. Section B is for graduates appointing a representative to collect the documents on their behalf. Section C collects details of the representative. The form requires signatures of the graduate and representative, as well as copies of identification documents and receipts.

Uploaded by

Adilah Azam
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as 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 : ......................

A. DETAILS OF GRADUAND

Name : .....................................................................................................................................................
MyKad/Passport Number : ............................................... Student Number : .........................................
Program Code : ..........................................
Correspondence Address : ......................................................................................................................
...................................................................................................................
...................................................................................................................
Mobile Phone Number : .......................................... E-mail : ..................................................................
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
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)

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

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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