《马来西亚英迪国际大学交流生项目申请表》.pdf

APPLICATION FORM - International Students Instructions to complete the application form : Please write in BLOCK LETTERS (in BLACK or BLUE ink only). Please attach :  Two (2) photocopy of passport (the entire booklet inclusive of all blank pages) (Passport should have at least 18 months validity / Indonesia Student: 30 months validity)  Six (6) passport-sized photographs with white background (size: width 3.5cm x height 4.5cm)  Two (2) Certified true copies of all academic qualifications (in English translation)  Two (2) Certified true copies of English Language Proficiency (if applicable)  IELTS  TOEFL  Others: ___________________________________________  Pre-arrival medical examination report  Medical Examination Report / Lab Report (if applicable)  No Objection Certificate (NOC) & Eligibility Letter (only applicable for students from Sudan & Iran)  One (1) copy of Yellow Vaccination Card (applicable for students from yellow fever endemic areas (e.g. Africa, Central & South America))  One (1) copy of Verification Report for academic certificates (translated into English and only applicable for students from China)  Release Letter / Visa cancelation page (only applicable for Transfer Students)  Other supporting documents for your application (where necessary) For Office use only Student ID  Accommodation form Salutation Mr. Ms. Mrs. Others ( please specify ) First Name ( as per in passport ) Passport Issued by Country Gender State / Province State / Province Last Name ( Family Name ) 3. Last Academic Qualification School / College / University City / Town Country State / Province Highest qualification obtained Year Results Forecast Actual Others ( please specify ) IELTS English Qualification Others TOEFL Score Year Taken ( please specify ) ( please specify ) ( please specify ) 4. Immigration Pass Information Are you holding any type of Malaysian Immigration Pass now ? If yes, please specify type of pass : Immigration Pass Expiry Date : No Yes Student Social Visit Dependant MM2H Diplomatic d d / m m / y y Applicable to students / former students from other institutions in Malaysia only : Institution : Course : Year / Duration : Applicable to students who need Single Entry Visa (SEV) : Please advise as to which Malaysian Consulate / Embassy you wish to obtain your SEV to Malaysia : ( please specify ) 5. Health Information Do you have any medical condition that need attention ? No Yes Handicapped If yes, please provide details : If no, I hereby declare that I am physically and mentally fit and there is no other medical condition or disability likely to prevent me or require special attention or care in relation to my study in INTI. 6. Funding Scholarship Self Funding Others ( please specify ) ( please specify ) 7. Programme Applied For Programme Level : Certificate Diploma Foundation / Pre-University Master / PhD Degree Others ( please specify ) Discipline : Art & Design Business Engineering Medical & Health Sciences Information Technology Languages Mass Communication Hospitality Programme Applied : Campus : Intake Powered by TCPDF (www.tcpdf.org) : INTI International University INTI International College Subang INTI International College Penang INTI College Sabah m m / y y y y Others 8. Important Notes NOTICE TO STUDENT OF PRIVACY AND DATA PROTECTION (“this Notice”) NOTIS PERLINDUNGAN DATA DAN PRIVASI PELAJAR (“Notis ini”) 1. INTI would like to inform you, as a student of INTI group of companies (“INTI”) that in line with the PERSONAL DATA PROTECTION ACT 2010 (“the Act”) that came into effect on the 15th of November 2013, INTI is required to ensure all personal data including sensitive data complies with the requirements of the Act. INTI wishes to assure all its students that INTI takes its students’ privacy seriously and is committed to the protection of its students’ personal information. Each INTI’s student therefore acknowledges that prior to signing the application/enrolment form accompanying this Notice, he/she has fully understood the nature and extent of the rights and obligations under this terms and conditions governing enrolment and admission and consequences if he/she fails to comply with the terms and conditions of this notice. INTI ingin memaklumkan anda, sebagai pelajar kumpulan INTI ("INTI") yang sejajar dengan AKTA PERLINDUNGAN DATA PERIBADI 2010 ("Akta") berkuatkuasa pada 15 November 2013, INTI dikehendaki memastikan semua data peribadi termasuk data sensitif mematuhi kehendak-kehendak Akta tersebut. INTI ingin memberi jaminan kepada semua pelajar bahawa INTI memandang serius terhadap privasi dan komited untuk melindungi maklumat peribadi pelajar. Setiap pelajar INTI perlu mengakui sebelum menandatangani borang permohonan / pendaftaran yang mengiringi Notis ini, pelajar telah memahami sepenuhnya hak - hak dan obligasi di bawah terma-terma dan syarat-syarat pendaftaran dan kemasukan dan akibat jika pelajar gagal mematuhi terma dan syarat-syarat Notis ini. 2. Please contact respective INTI campuses for access to your personal data or to notify us of any change in the information you have provided. Sila hubungi Kampus INTI untuk mengakses maklumat peribadi atau untuk memaklumkan kami berkenaan sebarang perubahan ke atas maklumat yang telah diberikan. 3. By signing this form, you confirm that you have read, understood the contents and voluntarily completed this form. If you are below 18 years of age, this form must be additionally signed by your parent or guardian. Dengan menandatangani borang ini, anda mengesahkan bahawa anda telah membaca, memahami isi kandungan dan telah secara sukarela melengkapkan borang ini. Jika anda berumur kurang dari 18 tahun, borang ini juga perlu ditandatangani oleh ibu bapa atau penjaga anda. I, a student of INTI have read and I fully understand the policies, terms and conditions governing enrolment, admission, and the nature and effects thereof listed in the application/enrolment form and this Notice. I hereby expressly confirm my agreement to the terms in the application/enrolment form and this Notice. I further undertake to perform all such obligations and/or comply with all terms and conditions set out in the application/enrolment form and this Notice on my part to be performed or complied with. I hereby consent to the processing by INTI of personal data (including sensitive personal data as defined in the Act) about me for the proper purposes of all institutions/companies within INTI in support of this application on the understanding that it may be used for all purposes as listed in the Student handbook and the policies and procedures governing privacy laws within INTI from time to time. I further confirm and consent to the use by the various departments of INTI to use my personal data/information, including without limitation my email, phone number, address and other relevant personal information strictly to achieve the following purposes:(a) for INTI to send reminders to me or to my parents/guardian on any outstanding payments, failure to settle outstanding and refunds of deposits and over payments and for any and all other matters relating to the payment of my fees; (b) for INTI to send to the various scholarship bodies such as PTPTN, all information required and or requested for in support of my application for scholarship; (c) for INTI to disclose to the relevant government bodies such other information as may be required by such government bodies from time to time; (d) for INTI to disclose my examination results to my parents/guardian; and (e) for INTI to store my personal data in a server within Malaysia or outside Malaysia. Saya, pelajar INTI, telah membaca dan saya memahami sepenuhnya dasar-dasar, terma-terma dan syarat-syarat pendaftaran, kemasukan, dan sifat dan kesan daripadanya yang disenaraikan di dalam borang permohonan / pendaftaran dan Notis ini. Saya dengan ini mengesahkan persetujuan saya kepada terma-terma di dalam borang permohonan / pendaftaran dan Notis ini. Saya seterusnya bersetuju untuk melaksanakan semua obligasi dan / atau mematuhi semua terma dan syarat yang ditetapkan di dalam borang permohonan / pendaftaran dan Notis ini di pihak saya yang hendaklah dilaksanakan atau dipatuhi. Saya dengan ini bersetuju dengan pemprosesan data peribadi (termasuk data peribadi sensitif seperti yang ditakrifkan dalam Akta) oleh INTI yang berkenaan dengan saya untuk tujuan yang betul di semua institusi / syarikat di bawah INTI dalam menyokong permohonan ini dengan pemahaman bahawa ia boleh digunakan untuk semua tujuan seperti yang disenaraikan dalam buku panduan pelajar dan dasar-dasar dan tatacara yang mengawal undang-undang privasi INTI dari semasa ke semasa. Saya mengesahkan dan bersetuju dengan penggunaan oleh pelbagai jabatan INTI untuk menggunakan data / maklumat peribadi saya tanpa had termasuklah akses kepada alamat e-mel, nombor telefon, alamat tempat tinggal dan maklumat peribadi lain yang berkaitan dengan tujuan berikut: (a) Untuk INTI menghantar peringatan kepada saya atau kepada ibu bapa / penjaga saya berkenaan mana-mana bayaran yang belum dijelaskan, kegagalan untuk menyelesaikan bayaran tertunggak dan bayaran balik deposit dan pembayaran lebihan dan semua perkara lain yang berkaitan dengan pembayaran yuran saya; (b) Untuk INTI menghantar kepada badan-badan biasiswa seperti PTPTN, semua maklumat yang diperlukan dan / atau diminta untuk menyokong permohonan saya untuk biasiswa. (c) Untuk INTI mendedahkan kepada badan-badan kerajaan yang berkaitan maklumat lain sebagaimana yang dikehendaki oleh badan-badan kerajaan itu dari semasa ke semasa; (d) Untuk INTI mendedahkan keputusan peperiksaan saya kepada ibu bapa / penjaga saya. (e) Untuk INTI menyimpan data peribadi saya didalam pelayan di Malaysia mahupun di luar negara. By submitting this Application Form and/or using the Online Enrolment Portal, I hereby agree that INTI may collect, obtain, store and process my personal data that I have provided for the purpose of administration, management, assessment, receiving updates, news, promotional, marketing mails or materials from INTI including disclosing information relating to my academic and/or finance records to my parents and/or guardian. I hereby give my consent to INTI to also disclose my personal data to the relevant governmental authorities or third parties where required by law or for legal purposes. In addition, my personal data may be transferred to any company within INTI which may involve sending my data to location outside Malaysia. For avoidance of doubt, Personal Data includes all data defined within the Personal Data Protection Act 2010 including all the data I had disclosed to INTI in this Form. By attending campus organized events, I hereby consent to the use of my photograph, voice, likeness, and image in any broadcasts of this event and in subsequent productions drawn from video or audio recordings of the respective event. The photographs and recordings may be published or broadcasted in the official INTI and affiliates’ publications and in publicity materials, including the INTI and affiliates’ websites and social media. All recordings, articles, quotes, photographs, films, audio or video and/or any reproductions of same in any form, are the property of INTI. INTI, its affiliates, employees, representatives and agents are released from any and all claims, demands, costs and liability that may arise from the use of these interviews, recordings, photographs, videotapes or films, and/or any reproductions of same in any form, as described above, arising out of being interviewed, recorded, photographed, videotaped or filmed. Dengan menyerahkan Borang Permohonan ini dan/atau menggunakan Portal Pendaftaran Dalam Talian, saya bersetuju bahawa INTI dibenarkan mengumpul, mendapatkan, menyimpan dan memproses data peribadi yang diberikan oleh saya di dalam Borang ini bagi tujuan pentadbiran, pengurusan, penilaian, penerimaan maklumat terkini, berita, promosi, surat pemasaran atau bahan-bahan daripada INTI termasuk mendedahkan maklumat yang berkaitan dengan rekod akademik dan/atau kewangan saya kepada ibu bapa dan/atau penjaga saya. Saya juga membenarkan INTI untuk berkongsi data peribadi saya dengan pihak berkuasa kerajaan yang relevan atau pihak ketiga yang dikehendaki oleh undang-undang atau bagi tujuan perundangan. Selain itu, data peribadi saya juga, boleh dipindahkan ke mana-mana syarikat di bawah INTI yang boleh melibatkan penghantaran data saya ke lokasi luar Malaysia. Untuk mengelakkan sebarang kekeliruan, Data Peribadi melibatkan semua data yang didefinisikan di bawah Akta Perlindungan Data Peribadi 2010, termasuk semua data yang saya kongsikan kepada INTI di dalam Borang Permohonan ini. Dengan menghadiri acara yang dikelolakan oleh pihak kampus, saya membenarkan penggunaan gambar, suara, persamaan dan imej saya dalam sebarang penyiaran acara ini dan produksi berikutnya yang diambil daripada rakaman video dan audio acara tersebut. Gambar dan rakaman mungkin diterbitkan atau disiarkan di dalam penerbitan rasmi INTI dan sekutunya serta digunakan di dalam bahan publisiti, termasuk media social dan laman web INTI dan sekutunya. Semua rakaman, artikel, petikan kata-kata, gambar, filem, audio atau video dan/atau sebarang produksi semula bahan yang sama dalam sebarang bentuk adalah milik INTI. INTI, sekutunya, pekerja, wakil dan ejen tidak akan bertanggungjawab daripada sebarang atau semua tuntutan, permintaan, kos dan liabiliti yang mungkin timbul daripada penggunaan temuramah, rakaman, gambar, video atau filem, dan/atau sebarang produksi semula dalam sebarang bentuk, seperti yang dinyatakan di atas, yang timbul daripada ditemuramah, dirakam, diambil gambar, divideokan atau difilemkan. Date / Tarikh d d / m m / y y Signature / Tandatangan Signature by Parent / Guardian Tandatangan oleh Ibu bapa / Penjaga 9. Terms and Conditions For Enrolment 1. All international students are required to pay an advanced tuition fee (equivalent to the 1st semester tuition fee and other miscellaneous fees), as a “Prepaid Fee” to secure your enrolment before the original approval letter is sent. 2. For subsequent semester / term, full settlement of semester / term fees is required upon enrolment or by the start date of semester / term. 3. All payments are to be made in the form of bank draft, crossed cheque, telegraphic transfer or internet banking to relevant Payee Name and bank account of INTI listed in the Application Form. 4. Fees paid are not refundable except in the circumstances set out below and provided that a request in writing for such refund is made to Finance: (i) Application and EMGS fees are neither refundable nor transferable. (ii) Subject to paragraph (i) above, if student withdraws from a programme before the commencement date of the semester / term, the refund of the prepaid fee would be considered and subject to approval. (iii) Subject to paragraph (i) above, if a student was refused a visa, the student will be eligible for a refund of prepaid fee paid by the student to INTI for the purpose of the student undertaking the programme if evidence is provided by the student that the student was refused an appropriate visa and that refusal caused the student to fail to commence the programme on the commencement date of the programme. (iv) Subject to paragraph (i) above, if a student fails health screening test, Registration Fee and General Admin Fee are not refundable but the student is eligible for a pro-rated refund of tuition fees paid. The pro-rated refund of fees will be computed based on the number of weeks that has elapsed from the date of commencement of the semester / term to the date of the student’s official notification to the Head of Programme and proportionate to the total number of weeks of the relevant semester / term. Refundable deposits will be refunded less any sums due to INTI, if any. 5. All payment of refunds shall be made payable to the name of the parent / guardian / sponsor (if applicable), as specified in the Application Form. 6. All refunds whether of fees, deposits or any other payments shall be free of interest and shall be subject to the right of set-off by INTI against any fees or whatsoever payments due and owing to INTI. 7. All claims for refund of any moneys (whether fees, deposits or any other payments) shall be made within two (2) years from the date the particular student ceases to be a student of INTI, failing which the student is deemed to duly authorize INTI to transfer the said monies to ‘INTI Alumni of Malaysia’, a society registered under Societies Act 1966. The Student shall thereafter have no claim in respect of such monies. 8. There shall be no refund (save and except refundable deposits) if a student is expelled from INTI due to academic misconduct or disciplinary behaviour. 9. For all semesters / terms, all fees must be fully paid by the start date of semester / term. A late payment charge of Ringgit Malaysia Three Hundred (RM300) will be imposed commencing from the second week of the semester / term. INTI reserves the right to review the status of the student and to take such necessary action as it deems fit, including but not limited to the deregistration of subjects enrolled (auto drop), barring the student from classes and facilities, suspension, withholding of all examination results, certificates and records of the student. 10. All fees are subject to annual revision. 11. INTI reserves the right not to open a class. 12. You are required to sit for an English Placement Test (EPT) to assess your English proficiency level. If you fail the test, you are required to enroll in the Intensive English Programme (IEP). If you pass the EPT, you may enroll for programme provided you have met all other English requirements as set by the Ministry of Higher Education, Malaysia at that time. 10. Declaration and Agreement by Applicant I declare that the information provided by me in this application form is true and correct. I acknowledge and agree :(a) That INTI reserves the right to vary or reserve any decision regarding admission or enrollment made on the basis of incorrect or incomplete information given by me. (b) To abide by all academic, administrative and examination rules and regulations of the programme and to uphold the integrity and good name of INTI at all times. (c) INTI shall have absolute right as it deems fit to defer, close or not to commence any module or programme; and to review, change and update subject curriculum in any programme. (d) To abide by the INTI Code of Honour, as outlined in the General Rules and Regulations in the relevant INTI Student Handbook. (e) The personal data you have provided in this form will be used by or on behalf of INTI to send you further details, including its events, academic programmes and marketing information. (f) Your personal data may be additionally shared from time to time with INTI’s appointed third party agents. (g) Please contact respective INTI campuses for access to your personal data or to notify us of any change in the information you have provided. (h) By signing this form, you confirm that you have read, understood the contents and voluntarily completed this form. (i) And I hereby declare that I am physically and mentally fit and there is no other medical condition or disability likely to prevent me or require special attention or care in relation to my study at INTI. Conditional Admission I understand that I shall only be offered conditional admission if I apply with forecast results, and if my official results fall short of the entry requirements, then I must either withdraw from the programme or enroll in a programme with lower entry requirements. Name of Applicant : Signature of Applicant : Date : 11. Declaration by Parent / Guardian / Sponsor Name of parent / guardian / sponsor Passport No. Relationship Father Mother Guardian Others ( please specify ) Telephone No. Mobile No. E-mail Address Signature of Parent / Guardian / Sponsor Date : INTI INTERNATIONAL UNIVERSITY & COLLEGES INTI INTERNATIONAL UNIVERSITY INTI INTERNATIONAL COLLEGE SUBANG INTI INTERNATIONAL COLLEGE PENANG INTI COLLEGE SABAH INTI INTERNATIONAL UNIVERSITY DU022(N) Persiaran Perdana BBN, Putra Nilai, 71800 Nilai, Negeri Sembilan Tel: 06-798 2000 OTHER CAMPUSES INTI INTERNATIONAL COLLEGE SUBANG DK249-01(B) 3, Jalan SS15/8, 47500 Subang Jaya, Selangor Tel: 03-5623 2800 INTI INTERNATIONAL COLLEGE PENANG DK249-02(P) 1-Z, Lebuh Bukit Jambul, 11900 Penang Tel: 04-631 0138 INTI COLLEGE SABAH DK249-03(S) 17-20, Phase 1B, Taman Putatan Baru, 88200 Kota Kinabalu, Sabah Tel: 088-765 701 international.newinti.edu.my | fb.com/INTI.edu Powered by TCPDF (www.tcpdf.org) Bank Account details of respective INTI campuses All payments are to be made through bank draft, crossed cheque or banking transfer to Payee Name and bank account of INTI as stated below : Campus INTI INTERNATIONAL UNIVERSITY Persiaran Perdana BBN, Putra Nilai, 71800 Nilai, Negeri Sembilan, Malaysia. Tel Fax (+606) 798 2000 (+606) 799 7536 INTI INTERNATIONAL COLLEGE SUBANG 3, Jalan SS15/8, 47500 Subang Jaya, Selangor, Malaysia. Tel Fax (+603) 5623 2800 (+603) 5633 4350 INTI INTERNATIONAL COLLEGE PENANG 1-Z, Lebuh Bukit Jambul, 11900 Penang, Malaysia. Tel Fax (+604) 631 0138 (+604) 645 7505 INTI COLLEGE SABAH Lot 17-20, Phase 1B, Taman Putatan Baru, Putatan Point, 88200 Kota Kinabalu, Sabah, Malaysia. Tel Fax Payee Name / Cheque Payable to Bank Account Details INTI International Education Sdn Bhd HSBC Bank Malaysia Berhad Account No: 351 418702 101 Swift code: HBMBMYKL INTI Instruments (M) Sdn Bhd HSBC Bank Malaysia Berhad Account No: 105 154371 101 Swift code: HBMBMYKL INTI International College Penang Sdn Bhd HSBC Bank Malaysia Berhad Account No: 105 154421 101 Swift code: HBMBMYKL INTI Kinabalu Sdn Bhd HSBC Bank Malaysia Berhad Account No: 392 047296 101 Swift code: HBMBMYKL (+6088) 765 701 / 765 723 (+6088) 765 682 f b.c o m /IN T I.edu int e rna t iona l.n e w in ti.e d u .m y For Office Use Only Type of Offer : Full EPT Required Conditional : Forecast result / Others Programme Offered : Exemptions A ut hori sed Recr uit ment A gent ’s Stamp (I f A ppl i cabl e) Remarks : Received By: Approved By: Name: Name: Date: Date: INTERNATIONAL-APPL FORM OCT2022