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BORANG KEBENARAN WAKIL MENGAMBIL IJAZAH DAN

TRANSKRIP AKADEMIK
AUTHORISATION FORM FOR THE COLLECTION OF DEGREE AND ACADEMIC
TRANSCRIPT ON BEHALF OF THE GRADUATE

MAKLUMAT GRADUAN Graduates Particulars


Nama Graduan : ________________________________________________________________________________
Name of Graduand

No. Matrik : ______________________________________________________________________________________


Matric No.

Nombor Kad Pengenalan/No. Paspot : ___________________________________________________________


Identity Card/Passport Number

Nama Program : _________________________________________________________________________________


Programme Name

MAKLUMAT WAKIL Representatives Particulars


Dengan ini mewakilkan penama di bawah mengambil ijazah dan transkrip akademik bagi pihak
saya:
I hereby authorise the person as below to collect my degree and academic transcript on my behalf:

Nama Wakil : ___________________________________________________________________________________


Name of Representative

Nombor Kad Pengenalan/Pasport : _______________________________________________________________


Identity Card/Passport Number

No. Matrik : ______________________________________________________________________________________


Matric No.

Hubungan : _____________________________________________________________________________________
Relationship

PERAKUAN PENERIMA Consent of Receiver

_______________________
Tandatangan Penerima
Signature of Receiver

(Nama :____________________________________)
Name

Tarikh: _____________________
Date

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